The Last Days of Sylvia Frumkin

Shortly after midnight on Friday, June 16, 1978, Sylvia Frumkin decided to take a bath. Miss Frumkin, a heavy, ungainly young woman who lived in a two-story yellow brick building in Queens Village, New York, walked from her bedroom on the second floor to the bathroom next door and filled the tub with warm water. A few days earlier, she had had her hair cut in a bowl style, which she found especially becoming, and her spirits were high. Miss Frumkin felt so cheerful that she suddenly thought she was Lori Lemaris, the mermaid whom Clark Kent had fallen in love with in the old “Superman” comics. She blew bubbles into the water. After a few minutes of contented frolicking, Miss Frumkin stepped out of the tub. She slipped on the bathroom floor and cut the back of her head as she fell. She put on an old nightgown and went downstairs to the office of the building to tell the night supervisor, Dwight Miller, what had happened. Miller looked at the cut, told Miss Frumkin to get dressed, and said he would drive her to the emergency room at Long Island Jewish—Hillside Medical Center, a short distance away. As Miller started the car, turned on the car radio, and began to drive toward the hospital, Miss Frumkin seemed to get excited. The radio was playin4 Paul McCartney’s song “The Lovely Linda.’ Unknown to Miller, Miss Frumkin thought that McCartney was singing the lyrics sarcastically, because he had fallen in love with her and was no longer in love with Linda, his wife. Miss Frumkin be to talk fervently to the radio. For a time, Wer was afraid she might jump out of the car. Miss Frumkin and Miller arrived at the emergency room at two o’clock. Miss Frumkin was interviewed and examined by a nurse. For a few minutes, she was in sufficient control of herself to let the nurse take her vital signs, test her neurological responses, and look at her cut, and to answer the questions that the nurse asked. Miss Frumkin became upset while waiting to see a doctor and an X-ray technician (she began to speak rapidly, and what she said concerned suffering from hypoglycemia and Wilson’s disease and being Cinderella, and didn’t make much sense); more upset when the X-ray technician took X-rays of her skull and the doctor sewed up the cut; and still more upset when it turned out that there would be a fairly long wait for the X-rays to be read. Miss Frumkin got so obstreperous while she and Miller were waiting that they were shown into a small treatment room, where they were joined by a hospital security guard. Miss Frumkin had made so many difficulties for the doctor who had stitched her cut—by flaunting her medical knowledge, testing his, accusing him of incompetence, calling hum names, and threatening to sue him and the hospital—that he had called for the psychiatric resident on duty to examine her. In the small treatment room, Miss Frumkin’s conduct became increas bizarre. She took off all her clothes, accused Miller of kidnapping her and making sexual advances, and then asked Miller and the security guard to have sexual relations with her. The minute the two men would cover Miss Frumkin with a hospital gown, she would disrobe again. Around three o’clock, Dr. Conrad Aaronson came to observe and question Miss Frumkin. He found that she knew who she was, where she was, and what day it was. He found that her memory was difficult to assess, because she displayed marked “loosening of associations” (ideas slipping off one track and onto another, completely unrelated one) and “circumstantiality” (getting bogged down in a morass of trivial details that impede communication of a central idea), and also because she was extremely agitated, verbally abusive, and uncoöperative. In addition, some of her ideas were paranoid, and she expressed “delusions of reference,” which is to say that she misinterpreted incidents and events in the outside world as having a direct personal reference to her: she told Dr. Aaronson not only that Paul McCartney had sung to her but also that she was going to marry another former Beatle, Ringo Starr. Dr. Aaronson described Miss Frumkin as “acutely psychotic.” His impression of her condition was that it was an acute exacerbation of chronic schizophrenia. He found that Miss Frumkin was in no shape to return to her room in Queens Village. She was asked if she would like to be admitted to the psychiatric division of L.I.J.-Hillside, where she had been a patient on two previous occasions. Instead, she asked to be taken to the Creedmoor Psychiatric Center, in Queens Village—a state mental institution. Miss Frumkin had been a patient at Creedmoor until about two weeks earlier

I met Maxine on that June 16th, a month after her thirtieth birthday, when she was admitted to Creedmoor. When she was fourteen, her condition had been diagnosed as schizophrenia, and she had first been hospitalized at Creedmoor when she was sixteen. She was released after five months and was able to finish high school, but shortly after her graduation she returned to Creedmoor for twenty-seven months. Since her second release, in 1969, she had been in and out of private, city, and state hospitals, but mostly in: the June, 1978, Creedmoor hospitalization was her eighth, and it lasted until February 9, 1979. The ninth was from May, 1979, to January, 1980. When The New Yorker went to press in the spring of 1981, Maxine was back in Creedmoor for the tenth time. For two and a half years, I observed Maxine’s progress and setbacks at close range, chronicling her life in detail, and showing some of the hazards she ran in state hospitals. One was receiving misdiagnoses of her condition from foreign-born doctors. She told the Asian psychiatrist who admitted her in 1978 that she was Mary Poppins. He wrote on her chart that he was unable to elicit any delusions and concluded that she was a manic-depressive. I had access to all Maxine’s medical records, which enabled me to document the course of her illness from its onset. Schizophrenia, which afflicts one per cent of the population, is the world’s most serious mental illness. Its symptoms include hallucinations, delusions, bizarre behavior, emotional withdrawal, and lack of motivation. The prevailing view of schizophrenia is that it is a variety of illnesses, many of which have a genetic factor that causes a chemical imbalance in the brain. Childhood environment that includes stress may, however, help to trigger the illness. It appeared that Maxine’s environment met the test of stress. Frances and Sidney Mason, Maxine’s parents, invited me to dinner at their house in Whitestone, Queens, on the first night of the Jewish New Year in 1978, when Maxine was home on a pass. Mrs. Mason observed that she had recently seen a couple whose daughter had often been a patient at Creedmoor with Maxine. The daughter had tried to commit suicide several times. Her last attempt had been successful, so her mother and father—he had been in poor health—were finally able to move to a warmer climate. On their last visit, “they looked so gorgeous,” and the father was in fine health. “It’s no wonder,” Mrs. Mason went on. “The cause of all their trouble was removed.” As Maxine, who was then about sixty-five pounds overweight and was exasperating her parents by overeating, reached for a fourth serving of food, she said, “Ma, are you trying to tell me something?” I wished I could crawl under the table. Thorazine and the other antipsychotic drugs that were introduced in the nineteen-fifties worked wonders on thousands of schizophrenics, enabling them to live in the outside world, but they worked only limited wonders on Maxine, even when she was properly medicated, which wasn’t often enough. She was frequently disagreeable, but what attracted me and others who knew her was her humor and her way with words. Listening to those Joycean monologues at Creedmoor made one wonder where her brilliance might have led her if her illness had not led her there. Soon after the articles first appeared in print, Maxine was home again. Mrs. Mason didn’t sound pleased to hear my voice when I telephoned Maxine every so often from my house, in Washington, but she always yelled “Maxine!” and Maxine came to the phone, unless she was watching a television show and shouted to her mother to have me call back later. Before yelling for Maxine, Mrs. Mason sometimes attempted to berate me for having betrayed her, but it didn’t seem appropriate to argue with her. Instead, I mailed her copies of some of the hundreds of letters the magazine’s readers had sent me—especially those from people who had concluded that she was a sympathetic figure, because there was nothing sadder than being the parent of a schizophrenic child. On the afternoon of March 2, 1982, Sidney Mason, while walking across a busy intersection near his house, was struck by a car. He was killed instantly. When Maxine called to tell me, she reminded me that her father always drove his Plymouth Valiant at the speed of about ten miles an hour, and said she had assumed he would be rear-ended and killed by an impatient driver—a thought that had also occurred to me when I was his passenger. Maxine rarely spoke of her father again. The hardcover edition of the book was published a month after his death. Maxine wanted to accompany me on the publicity tour—she was especially eager to appear on “60 Minutes”—but her mother threatened to throw her out of the house if she went on any television show. Having succeeded in keeping Maxine off the air, Mrs. Mason began sending me favorable reviews of the book, courtesy of the postage meter in the office of the charitable organization. I was determined that my friendship with Maxine wouldn’t end with publication. We had grown close as a result of the amount of time we had spent together at Creedmoor, sometimes sleeping on beds not far apart, and we had shared some good times. One day, I accompanied Maxine to the diner across the street from one of the gates, which was frequented by patients with grounds privileges. She introduced me to the proprietor-cashier as “the writer who is writing the story of my life.” As we were eating lunch at a table near the register, we saw the proprietor point to Maxine and overheard her telling a trucker, who appeared to be a regular, “Now, that one, she’s been coming here for ages and she’s just your run-of-the-mill lunatic.” Pointing in my direction, the proprietor continued, “But that new patient is in really deep trouble. She’s so delusional she thinks she’s a writer.” Maxine smiled and said to me, “Susan, you could never be as good at being crazy as I am.” Maxine loved Manhattan. Spending a day there with her was an adventure. We met for brunch a few times at her favorite restaurant, the Cheese Cellar, in the East Fifties, where she always ate enough for six. As she almost always did when we ate out together, she asked me what I thought of her table manners. They were atrocious, but, mercifully, she never waited for a reply, because she had much more to ask of the waiters. Could she take the large menu on the table home as a souvenir? Yes. What about the table napkins? Of course. And one of the posters on the wall? No problem. Even when Maxine was not psychotic, she was different, and the waiters recognized and responded to this difference. One Sunday, we left the Cheese Cellar laden with Maxine’s trophies, plus a week’s worth of food for her mother, which the waiter had wrapped up for her and presented in a Saks Fifth Avenue shopping bag. We were going to the theatre to see “Annie” and had more than an hour to spare. I asked Maxine if she would mind going with me to Fortunoff, where I wanted to buy a birthday present for my aunt. She did not mind, but she walked there slowly, stopping at the trash can on every street corner, foraging for the coupon sections of discarded Sunday newspapers. At Fortunoff, Maxine remembered that she had an envelope containing coupons that she needed to mail. By a miracle, the envelope had a stamp on it, but the glue on the envelope flap wasn’t sticky and she couldn’t seal it. “Fortunoff’s is the solution,” she said. As we went from the top floor to the ground floor of the store, I looked at silver, crystal, and china. While I was choosing my aunt’s present, Maxine asked the women who were wrapping gifts on every floor for a piece of Scotch Tape. The gift wrappers responded as the waiters invariably did, and the envelope was soon securely closed with four pieces of tape. Maxine loved “Annie,” and sat through it reasonably quietly. At intermission, she said she wanted a drink. I gave her the money for it and stayed in my seat, watching over her shopping bag (it was filled with Belgian waffles and whipped cream, an assortment of meats and cheeses, and a dozen pieces of cake) and our coats. She returned with orangeade, looking flustered. “I don’t know why that lady over there is so upset with me,” she said, settling into her seat and laying her large pocketbook on her lap. “All I did was hit her daughter on the head with my pocketbook, and I didn’t mean to. Accidents happen.” Our friendship was not easy to sustain, because the underside of the schizophrenia which the medications could not reach was always with Maxine. Her illness made her extremely egocentric and unhappy. It would have been cruel of me to hold Maxine to standards she could not meet, so I tried to make the friendship work by being a friend on her terms. Just as I did not criticize her table manners, I also did not object to her coupon searches while walking in Manhattan, or tell her that my other friends either accepted phone calls when they were watching television or said they would call me back later. I let Maxine choose the restaurants, the plays, the movies, and I laughed when she told a joke for the tenth time. Yet nothing was ever simple. Giving her a gift was often as complicated as going on an outing. Once, when she was getting ready for a trip to Niagara Falls, I mailed her a box of what I considered thoughtful birthday presents. I no longer remember what all of them were, but one was luggage tags inscribed with her name and address, and another was a travel diary. She found fault with them. On this occasion, thinking it would benefit her to learn to say “Thank you” if someone gave her a gift—or, at least, to practice the virtue of golden silence—I lit into her. From then on, she sent me short, polite thank-you notes. “The potpourri sits on my cabinet and makes my room smell like a spice garden,” she wrote in December of 1983. I would have been angrier with myself for this misguided attempt at behavior modification than I already was if Maxine hadn’t found a way to retaliate. In 1978, while I was still interviewing her for the articles, she asked me the color of my bedroom (blue) and had me meet her in a Queens department store to buy her crochet needles, an afghan pattern book, and many skeins of acrylic yarn in white and three shades of blue. No afghan came. A few years later, following my thank-you lecture, the afghan arrived. It was beautifully crocheted and had a label sewn into it that read “Made especially for you by Maxine Mason.” I was deeply moved, and said so, thanking her then for what I regarded as a labor of love, and repeating my appreciation many winters thereafter. My gratitude didn’t mollify her. “You’ve never given me a present that can compare to the afghan,” she said. I didn’t know how to respond, and Maxine didn’t care for golden silence. “I gave you a book, and you’ve really never given me anything,” she added. When Maxine’s schizophrenia was first diagnosed, she had been given antipsychotic drugs, whose purpose is to help correct the failure of schizophrenics’ brains to work the way normal people’s brains work. Over the next seventeen years, f was given many of the twenty or so antipsychotics then in use in America, because she failed to respond well to any of them. (About fifteen per cent of schizophrenics are what is known as “treatment-resistant.”) Maxine, like many schizophrenic patients, tended to stop taking her medication when she felt well—that is, when she was stabilized on a certain medication—and she also didn’t take it when she considered herself “born again,” as she did from time to time after 1974. (Many schizophrenics hear voices, so they tend to be preoccupied with religiosity.) Since Maxine was treatment-resistant, she tended to need more medication than other patients, and would become psychotic again, or “decompensate,” when she was undermedicated or had stopped taking her medications altogether. Nonetheless, Dr. Seaman kept her well medicated for quite some time. I kept carbons of some of my answers to the “What ever happened to Sylvia Frumkin?” letters. One reply, dated March 26, 1984, relates the effect that Dr. Seaman’s treatment was having on Maxine:

Sylvia Frumkin [I did not violate Maxine’s privacy during her lifetime] is doing quite well. She has not had a psychotic episode since 1981 and has now been out of an institution for longer than any time in her adult life—going on three years. The credit for this belongs to the psychiatrist she is seeing, who has her well medicated and who seems to be giving her the type of therapy that is of help to her. However, Sylvia is still not employable. She goes to job interviews but there is something about her that makes people wary of hiring her. . . . Her mother has just been diagnosed as having cancer. . . . I don’t know how many months or years she has left. [Her] death will have a profound effect on Sylvia. On the one hand, there won’t be the terrible daily battles, which continue just as they did in 1978, 1979, 1980. On the other hand, Sylvia will have no home and will have to live in some sort of communal housing, which she doesn’t fare well in. [Her] mother’s death could precipitate a “sink or swim” situation and I hope Sylvia will swim.

In late July and early August of 1984, Frances Mason was dying of cancer of the esophagus at Beth Israel Medical Center. Making hospital visits was difficult for Maxine, I went to see Mrs. Mason alone, or with Trudy. By then, she had admitted to Trudy that she felt having a daughter like Maxine was a shanda (Yiddish for “disgrace”). I had held up a mirror to the family, and Mrs. Mason hadn’t liked her reflection, but it was accurate and she seemed to have forgiven me. She was brave to the end, which came for her on August 11th. Frances Mason was buried next to her husband in a cemetery in New Jersey. The double gravestone has chiselled on it Sidney Mason’s dates of birth and death, but, at her request, Mrs. Mason’s inscription includes no date of birth. On her deathbed, she had said to Trudy, “I feel guilty that I’m leaving you with this burden. You must promise not to let your life revolve around your sister, but I’ll rest peacefully because you’ve promised me willingly that Maxine will befarzorgt,” or looked after. Maxine was thirty-six when her mother died. Many parents abandon their schizophrenic children before they reach that age. Young people with schizophrenic siblings often move far away from home, even during their parents’ lifetimes. A nurse at Bellevue once observed, “Most of our patients don’t have relatives. They have worn their families out.” Yet Trudy, who was born six years before Maxine, would not have deserted her sister, whatever her mother’s final mixed message. In 1963, the year Maxine received her first diagnosis of schizophrenia, Trudy graduated from Wheaton College and returned to New York. Three years later, while working in the first of numerous government jobs she came to hold, she was already the Masons’ designated driver during Maxine crises; in 1966, she drove Maxine from Greenwich Village back to a psychiatric hospital in Queens that she had run away from. In 1978, right after we met, Trudy was appointed director of government affairs and community relations for the New York State Metropolitan Transportation Authority. In 1984, she left the M.T.A. to become New York State press secretary for the Mondale-Ferraro campaign. Trudy was well wired, and, to her credit and her sister’s benefit, she never hesitated to a wire on Maxine’s behalf. In the spring of 1984, Maxine couldn’t find a job, so Trudy helped procure one for her at a Medicaid office on West Thirty-fourth Street. The job, for which Maxine qualified as a disabled person, paid the minimum wage. She started off as a receptionist, but found answering phones and taking messages too stressful. She retreated to being a file clerk, and immediately complained to me about the boredom of filing. “I’d rather stay in bed all day,” she said. By late summer, Maxine was living alone in the Whitestone house, because of their mother’s hospitalization—an arrangement that made Trudy uneasy, and for good reason. Maxine had never been able to survive on her own, even in a room at the Y. She was careless and lazy. The neighbors came over one day after Maxine had put all the dirty dishes in the kitchen sink and turned the water on—”so that the dishes would wash themselves” and found water all over the floor. Once when Trudy visited, the kitchen stove was on and Maxine was holding a dish towel close to the gas flames. Toward the end of 1984, several months before Trudy sold her parents’ house, she was able to place Maxine in a supportive-living program that offered apartments to former mental patients. Maxine joined two other young women in a two-bedroom apartment in Astoria. To be admitted to such an apartment, one either had to go to school or to a job, do volunteer work, or attend a supervised day program. Residents were expected to shop and cook and to keep their apartments clean. Twice a week, a program staff member came by to check up on them. In July of 1985, Maxine called me to say she couldn’t get along with her roommates and hated her job. She was upset about the possibility of being thrown out of her apartment but was unyielding in her refusal to clean the place up. I had tried to humor her into liking filing, and I attempted the same tactic now with cleaning, but Maxine could never pick up a sponge with a light heart. That fall, she saw Dr. Seaman erratically, had a psychotic break, and landed in Elmhurst, a city hospital in Queens. In February, 1986, she was back in Creedmoor, for the first time in five years. When Maxine was about to decompensate, she would become involved with a religious group—Buddhists, Jews for Jesus, or born-again Christians and hear “the voice of God” telling her to stop taking her medication. She telephoned me from Elmhurst to say she had had a relapse, and told me—not for the first time—that I was a Christian but would burn in Hell, because I had not been born again. She wrote:

Trudy and I went out for my birthday and I got my haircut. It was done by the owner of the salon. Without reservation it is practically the best haircut I ever had! It is called, or at least I think it is called the Cap Cut. I also had a manicure and a pedicure. The girl who did my pedicure struggled anc I mean struggled for almost or more than an hour with my calouses because the last time I had had a pedicure was before I went to Elmhurst General Hospital, and that was almost 8 months ago, and calouses have a way of growing a umongous amount in 8 months. So any way, we ate out and we had a surprisingly good time and since then we have been nice to each other on the phone except that she still likes to lecture. But thank goodness the bitterness is gone. There is other news, good and bad. I had the screening interview for the apartment program for readmission. They told me that I would know in a week if I am back in (good news), but they don’t know when trey will have an apartment available (bad news). So isn’t that delightful. Here I am stuck in a mental hospital and I am no longer mentally ill and have not been for a month according to both my doctors (Dr. Seaman included), my sister, and other people who know me. Such is life. What’s more I don’t know how long I will have yet to remain. I’d say such is lite but this place is as you well know like the opposite of life as we know it. But what can I do???? So be it.

Then, in a long P.S.:

There was something very important that I forgot to tell you. In September I may (a very definite may) be going back to school. LaGuardia Community College . . . has a program for discharged psychiatric patients, in which you stucy one of the Human Services Disciplines. In two years, if I can stand it, I’ll be the proud possessor of an Associate of Arts (A.A.) degree. Then I hope to go for a Batchelor’s and finally a Master’s in Music Therapy.

Maxine didn’t go to LaGuardia Community College in the fall. She had quit the Medicaid job before she wound up in Elmhurst, and to qualify for admission to another apartment in Astoria she volunteered to read to the blind. She soon quit that, too. In March of 1987, Trudy asked a friend to give Maxine a part-time job with Special Citizens Futures Unlimited, Inc., an organization that provides vocational and residential services for autistic, young people. Maxine was given carfare and lunch money in exchange for assisting with fund-raising and mailings. In mid-May, Peter Yarrow, of Peter, Paul & Mary, who is a close friend and a former beau of Trudy’s, sang at a benefit for Special Citizens, held at the Copacabana. Maxine greeted people and gave them their table assignments. In August, the friend asked Trudy for an out: the office was small, and Maxine’s presence was intolerable—she was much more difficult than the friend’s autistic brother. Her dirty clothes got progressively dirtier and she refused to bathe. Trudy’s friend said that Maxine’s eating habits were a problem, and added, “She was not just irritating and upsetting, she was malevolent, cantankerous, invasive, and draining to be around. Whatever you did for her and gave her, it was never enough.” By then, Maxine had also been asked to leave the supportive-living apartment, because her presence there was equally intolerable. That summer, Maxine was apartment hunting in Queens. She received monthly checks from the Social Security Administration, because she had been severely disabled before she was twenty-two, and whenever she wasn’t in the hospital she also received a monthly Supplemental Security Income check. These checks gave her a modest income, to which Trudy added. Maxine found an unfurnished studio apartment in Jamaica Estates for four hundred dollars a month. During this period, Trudy was having joint sessions with Maxine and Dr. Seaman, and, with the blessing of her own therapist, she met with Dr. Seaman alone to discuss Maxine. Trudy remembers his saying that if Maxine were given the responsibility of maintaining an apartment she would rise to the occasion. In late August, Maxine apparently stopped taking her medication. She entered Gracie Square Hospital, a private hospital, in mid-September. While Maxine was there, Trudy went to look at the Jamaica Estates studio. On September 21st, against her better judgment, she gave the landlord a check for the security deposit and the first month’s rent. She had to co-sign the lease, because Maxine had no banking or credit-card history. Maxine, back on medication, moved into the studio on October 1st. To enter Maxine’s building, which was three stories high, one went down three steps. Eight apartments and a laundry room were on this English-basement level. Maxine’s studio—her first apartment of her own—had kitchen appliances on one wall of the bedroom—living room; a window running the length of another wall; and a separate bathroom. It was originally furnished with pieces from her parents’ house, a recliner from one of the Astoria apartments, and several new purchases, among them a high-riser, so that a guest could spend the night on the pullout bed. Maxine said she was eager to work, and Trudy got her another low-paying job—as a messenger for the city. Maxine’s enthusiasm for being a messenger quickly waned, and, she dismissed my attempts to tell her that walking was the best possible exercise. “It’s demeaning, my sister is a big shot, and I hate exercise,” she retorted. She was five feet four, and by 1988 she weighed over two hundred pounds. She huffed and puffed as she walked from one city building to another delivering mail in lower Manhattan. In November of 1988, not long before Trudy was due to leave for a conference in Israel, Maxine disappeared. The Masons had always cancelled their modest plans when Maxine had “an episode,” but Trudy was determined to lead her own life while overseeing her sister’s. After Mrs. Mason’s death, Maxine rarely mentioned her mother to me, but she periodically called Trudy Mommy. “I am not your mother, and I’m not going to behave like your mother,” Trudy often corrected her. Knowing from experience that Maxine would be found when she wanted to be found, Trudy flew to Tel Aviv. She beeped her answering machine from a public phone on a street in Jerusalem. Among the messages was one from Gideon Seaman, who said that Maxine was staying in New Jersey with some Christians and sounded all right. Trudy returned to New York on December 6th. A week later, Maxine resurfaced—in a psychiatric hospital in New Jersey, where she remained until March. In 1987, Maxine had opened a checking account. She chose pretty, flowered checks, which she carried in a flowered pink checkbook cover; pink had been her favorite color since she was a child. She was close to forty when she got her first private telephone, rented her first safe-deposit box, and opened her first charge account—at Lane Bryant, a store that carries only large sizes. She was proud of these symbols of adulthood, which those of us to whom life has dealt a better hand tend to take for granted. She sent checks to cover her phone and utility bills, gave periodic checks to a cleaning woman or a cleaning service, and to a drugstore for her medications. She dispatched numerous checks to mail-order houses—to L’eggs for socks, to Colonial Garden Kitchen for gadgets, to Columbia House for cassettes, and to “The Best Catalogs in the World” for more catalogues, for which she paid two dollars apiece. Maxine wore out the narrow highriser, which had a thin mattress (she never lay down or sat down—she clunked down), without ever entertaining an overnight guest. When she was young and slender, she had occasionally dated, but no one knew for sure whether she had ever made love to a man. As she grew increasingly obese and careless about her hygiene, it seemed less and less likely that she had a sex life. Although she told dirty jokes, she was narrow-minded and straitlaced. She badmouthed lesbians, gays, and other minorities. When I took my mother and daughters to the movies with Maxine in 1980, she had whispered loudly in my ear that the kissing scenes were “a bit risque” for the children (who were then eleven and thirteen) and for my mother. Maxine never spoke of being idle—a fact I attributed to the greatest ability to make mountains out of molehills I have ever observed. A single mail-order purchase easily became a weeklong obsessive enterprise. The musical-note magnets she ordered for her refrigerator pleased her, but a yogurt-maker did not. Getting it back into the box (Maxine was clumsy), addressing the label (she wrote slowly and her handwriting was difficult to decipher), and taking it to the post office consumed her. Her phone bills often came to more than a hundred dollars a month. She telephoned mail-order houses (the ones she favored did not have 800 numbers) to chat with customer-service operators about prospective purchases and returns. Every once in a while, Maxine thought that she had found a friend—usually a woman she had met in one or another psychiatrist’s waiting room who suffered from some less serious form of mental illness. She often called the prospective friend a dozen times a day, quickly driving her away. Maxine’s phone bills included very few phone calls to friends. As proof of my affection, she wanted me to call her. When I did, the television set was usually on, and, over time, it distracted her increasingly; I could also hear her slurping a beverage or munching crackers. The doorbell sometimes rang as she was talking—I eventually became an almost silent listener—and when Chinese carry-out food arrived she dug right in to it noisily, still talking. At Bellevue, Dr. Seaman told the admitting doctor the medications on which he had maintained Maxine for nine years—when she took them—and left. According to the Bellevue doctor, Maxine was talking to herself, mumbling incoherently, suffering from delusions of grandeur (”I am an actress”), and religiously preoccupied (“You are cursed by the Cross”). At Bellevue, Maxine was put back on her medications (she admitted she had stopped taking them) and was treated for various physical ailments, including a urinary-tract infection. Although she barely functioned at Bellevue, she was discharged on March 27, 1991. Over the next five weeks, her condition deteriorated. The apartment was bearable for a few days after its latest professional cleaning; then the smells of sour milk and orange juice in unemptied containers and the odor of stained bedclothes and soiled underwear pervaded the hallway, and the neighbors complained yet again. On May 2, 1991, Maxine failed to show up for an appointment she and Trudy had with Dr. Hyder. Trudy called Maxine’s super, and learned that Maxine was not in her apartment that day. The super telephoned Trudy on May 3rd. He had heard loud music coming from the apartment all night, and now Maxine was sitting on the front steps of the building tearing up books and giving away cassettes. When Trudy reached the apartment, around midday, Maxine had wandered off. Trudy headed for a neighborhood Pentecostal church that Maxine had been attending, but she wasn’t there. By the time Trudy returned to the apartment, Maxine had come back and taken off again. Trudy looked for her in vain in shops along Jamaica Avenue. Finally, she saw Maxine sitting on the top step of a subway entrance, wearing only a sweatshirt, shorts, and sandals, eating a Whopper from Burger King. “Maxine, I’ve been looking all over, and everyone’s so worried,” Trudy said, as she approached her. “You can’t follow me, and I’m going to the movies,” Maxine snapped, pushing her sister away and running down the stairs. For a while, Trudy pursued Maxine up and down stairs, but Maxine finally got through a turnstile. The station was large, with four sets of tracks and two platforms. The chase continued as trains came and went. At one point, Maxine beat Trudy with her hands and then ran off; Trudy caught up with her just as she boarded an F train. “This woman is trying to kidnap me!” Maxine shouted. “She’s from the thought police!” Some passengers sat still, ignoring the scene; some moved to other cars. At Queens Plaza, where the F and R trains converge, Maxine scampered off the F train; pushed Trudy, who was begging her to calm down, out of her way; and got on an incoming R train. Trudy, who had followed her, screamed, “Please, is there a police officer on this train? My sister is mentally ill,” as Maxine started running up and down the car. Maxine calmed down a bit at the Lexington Avenue stop, and Trudy asked her if she wanted to go to Bloomingdale’s. Maxine didn’t answer. Out of desperation, Trudy pulled the emergency cord to stop the train as it approached the Fifty-seventh Street station. As a former M.T.A. executive, she expected that her action would bring a transit-police officer into the car. The train stopped before entering the station. The officer directed everyone else in the car in which Maxine and Trudy were riding. to other cars, then signalled the engineer to start up again. The engineer pulled the train over to a sidetrack, and the other passengers disembarked. Trudy identified herself to the transit police, explained that Maxine had recently been released from Bellevue, and asked them to call the Emergency Medical Service. Trudy then got off the car. While waiting for the E.M.S. to show up with an ambulance, she looked at Maxine, who was alone in the sealed-off car, alternately sitting, standing, pacing, running, jumping, and banging on the windows. Trudy thought, Maxine always said we were making a movie, but how did things come to this? The following evening, Trudy telephoned me and recounted the chase. She said that it had been the most harrowing day of her life. I realized that she was upset with herself. Pursuing Maxine was what her mother had done and what she had therefore vowed never to do. Clozaril has one major drawback, however: it can cause agranulocytosis, a potentially fatal condition resulting from a major decline in the white-blood-cell count. Therefore, patients using it have to be given weekly blood tests. With this mandatory lab work, Clozaril cost about nine thousand dollars a year per patient when it was introduced. Although Maxine initially shouted at Dr. Graham, “I don’t want to take it!,” she started taking Clozaril on September 15, 1991. Her white-blood-cell count remained satisfactory, even as Dr. Graham gradually increased the dosage until he found the correct level. Dr. Graham’s caseload is high, and he had not seen Maxine for more than two years when we spoke after her death, but he had no trouble remembering her. “I’d paint Maxine in bright colors and most other patients in gray,” he said. “She was so fat, so noisy, so unhappy, she dressed in a bizarre fashion, and she was so grandiose.” In Dr. Graham’s opinion, Clozaril made Maxine more pleasant but only marginally better. When he reviewed her chart for me, he noted that in March of 1992 she was able to sustain her attention in arts and crafts for twenty minutes and to serve as the caller in bingo for ten minutes, “but she basically stayed in her own room and in her own world.” This time, Maxine stayed in Bellevue, a city hospital intended for shortterm patients, for fifteen months—from May 3, 1991, until August 18, 1992, when she was released to Fountain House, one of the most highly regarded community programs in the country for discharged mental patients. The cost of her Bellevue stay was $381,625, paid for by Medicaid and Medicare. Trudy paid the rent on Maxine’s apartment during the entire stay, in the hope that Maxine could progress through the Fountain House program back to her studio. Trudy kept in touch with the professionals who were caring for Maxine but often wished she had a sister who wasn’t mentally ill, one with whom she could share her life. “When I was with friends, they would talk about their children and then they would say ‘And how is Maxine?’—as if she were my child,” she told me. “With Maxine, especially in her later years, I had all the negatives of having a child and none of the positives, none of the joys and the pride.” At Fountain House, Maxine refused to take Clozaril, and began assaulting the staff, consuming entire gallons of milk and jars of mayonnaise, and regressing to infantile behavior; she was brought back to Bellevue on September 2, 1992. Trudy and a Bellevue social worker had warned her that if she acted out at Fountain House she would end up in a state hospital. She hadn’t believed them. On October 20, 1992, she was transfeired to Rockland Psychiatric Center. “Maxine was given a fair trial on a fair dose of Clozaril between September, 1991, and August, 1992,” Dr. Graham told me. “It didn’t work very well for her, although I think Clozaril helped her as much as any medication currently available could have, and I wish she had kept taking it.” The drug has lived up to its promise for a significant number of others for whom it has been prescribed. Trudy Mason had first run for public office in 1985, as a candidate for City Council. She hadn’t mentioned her schizophrenic sister then, still affected by her mother’s mental-illness-is-a-shanda legacy. Trudy lost that race, but in 1991 she decided to run for the State Assembly. Trudy had become an advocate for the mentally ill, and, shortly before the race, she identified herself as the sister of a schizophrenic. A few days after Maxine’s death, when I told Trudy that I wanted to write the last chapters of her story, she agreed, on one condition: that I write about Maxine Mason, not about Sylvia Frumkin. “The only way to take the stigma away from schizophrenia is to talk about it in public ,” she said. Rockland State Hospital, where part of the movie “The Snake Pit” was filmed, in the late forties, opened in 1931. At its zenith, in 1955, its numerous buildings housed ninety-two hundred patients, many of them for years. There are now six hundred and seventy inpatients at Rockland Psychiatric Center (as it was officially renamed in 1975), and the average length of stay is sixty-five days. As Trudy, who is currently working as a freelance public-relations consultant, and I drove to Rockland on Thursday, December 15, 1994—exactly four weeks after Maxine’s death—I reminded her that Maxine had telephoned me only once during her two years there. I had been out when she called, so my husband had accepted her collect call, but all she could do was breathe hard and mumble a few unintelligible words. Between 1992 and 1994, Trudy had thought it best that I and Maxine’s other friends not visit. Trudy is angry over Maxine’s death. She is bitter that no bleeding ulcer was detected in a physical examination Maxine had been given only four weeks before. (Doctors at Rockland say that there was no indication of any problem then.) Trudy and her best friend, a psychiatric social worker, met at Rockland a few hours after Maxine’s death. They say they were given inconsistent accounts of the precise circumstances of the death. Because Trudy isn’t certain how long Maxine lay on a floor before she was found and a doctor and the paramedics were summoned, she has retained a law firm to file a notice of intention to file a wrongful-death and personal-injury claim against Rockland. When we were admitted to Building 32, Ward 68, I was overwhelmed by the smell of urine and disinfectant. I hadn’t smelled that smell since I last visited Maxine at Creedmoor, some fourteen years earlier. She had spent almost a year and a half at Rockland in the Admissions Unit before being transferred to this unit, for extended-care patients. The patients I saw sitting in the day-room chairs as we entered appeared to range in age from their thirties to fifty-plus. They had one feature in common: their eyes were glazed. Maxine’s vision was poor and she wore very thick lenses, but she often lost her glasses, and I recalled how pretty her blue eyes were, and how lively they looked even when she was quite ill. Her last room, which she had shared with three other patients, was empty. I walked into it, took off my shoes, and lay down on the bed that had been hers. As soon as my head touched the pillow, I was again transported back in time to Creedmoor. The pillow was identical to the one that Maxine had used every night there. The first time I slept at Creedmoor, I couldn’t believe how hard and uncomfortable the pillows were. I had taken off the white pillow slip then, and did so now, and saw a pillow cover made of the same stiff, poison-green-colored oilcloth. It costs an average of $100,400 to keep a patient at Rockland for a year, and yet, with all that money, there were no decent pillows. The staff at Rockland was extremely courteous to us. I had brought along a few of my letters from Maxine—she was the only person who ever wrote letters to our cat, enclosing coupons for cat food and inquiring after Fearless Fosdick’s well-being—and I let the staff read my favorite: the letter from May, 1986, in which she had hoped, in vain, to attend LaGuardia Community College. The letter ended with the words “so, once again I close with a fond farewell. Take care and hope to hear from you soon. Love and all again, Maxine.” The doctors, social workers, and treatment-team leaders all agreed that the person who was able to write such a letter had died long before Maxine. On these pages Maxine’s soliloquies are described as “word salad.” No Joycean monologues appear, because “the writer who is writing the story of my life” was not there to record them. I find a trace of my former presence on only a couple of pages—when Maxine is insisting that she is Sylvia Frumkin and someone is doubting her. At dawn, I wrap the afghan tighter, I pet Fosdick, I let the pages tumble to the floor. I am about to drift off to sleep, but not, Maxine, before I once again close with a fond farewell. • ♦