SCHUYLKILL ASYLUM
Reading, Pennsylvania
REQUEST FOR DISCHARGE
PATIENT: Joseph Albert Nelson
DOCTOR: Dr. Francis Johnston
I first met Joe Nelson in the spring of 1919, after he had gotten out of the military hospital. Bullet in the leg. Has to walk with a cane now, at the age of 23. Went berserk in the hospital after a few weeks. Raving about the gas, the gas… That’s when they sent him here. The journey back across the ocean can’t have been pleasant with his leg injury. At first, Joe refused to talk with me. With anyone, really. He looked at the ceiling most of the time. I can’t imagine what he must have been seeing. Horrible things, no doubt. He finally spoke the fourth time they brought him to me. Didn’t say much, but he spoke. I could tell he was under conditions of immense stress due to war trauma. I noticed especially his reluctance to speak about his wife, Edith. I believe he felt guilt for leaving her to go off to the war. He couldn’t help it, of course. He was drafted. I believe this is a manifestation of his psychosis. He went into a state of severe emotional distress whenever I mentioned Edith. To illustrate this, I have included a transcript of my first conversation with the patient with this report.
Of the veterans we got after Armistice, Joe was one of the saner ones. After talking to him, I was initially surprised that they had sent him here. We usually don’t get his type. But after further conversation, I saw why they couldn’t send him home. As is obvious from our first interview, Joe had a deep mental connection between his home and the war. They were tied together. That is, of course, why we had to send him back to his father’s house instead of his own. I don’t know if he’ll ever reconcile with Edith. Last week, he received a letter from her. She mentioned divorce. He did not take it well.
In the weeks since he arrived here, Joe has made slow progress. Before we could get him to talk, he was constantly having flashbacks. Flashbacks trigger breakdowns, so we did the best we could to stop him. The few times he got violent, we had to tie him to the bed. Thankfully, he has not had a violent episode in three weeks or so.
He has been speaking more and more, and less and less about the war. Last week we had him talking for an hour about fishing, a good sign of increasing stability. So, this week I agreed to his request for discharge. We are getting a slow trickle of veteran patients, and Joe’s spot could be taken by someone with more need. I don’t think he will ever get over the war; no one can, not completely. He will probably continue having nightmares, perhaps his whole life. It’s tragic, but it’s not something we can change.
JOHNSTON: Hello, Joe, I’m Dr. Johnston. You can call me Frank. [No response.] Well, to start off, Joe, can you tell me about yourself? [No response.] Joe, I can’t help you if you don’t talk to me.
NELSON: I don’t need help.
JOHNSTON: I think we both know that’s not true, Joe. You wouldn’t be here otherwise. [No response.] Can you tell me about where you grew up?
NELSON: I thought you were supposed to help me with the WAR! Goddammit, how is this gonna help?
JOHNSTON: Please, Joe, this will help you in the end. It says here you lived in Ohio. Near Cleveland.
NELSON: Yeah.
JOHNSTON: Tell me about Cleveland.
NELSON: Hell, it’s Cleveland... Big city with factories. The people never stop on the street. I worked at my father’s hardware store. At school I met… met...
JOHNSTON: Edith?
NELSON: Edy. Now don’t you go and ask me about Edy.
JOHNSTON: When was the last time you had contact with her?
NELSON: My last letter from the hospital.
JOHNSTON: How has she been getting along since you left?
NELSON: I don’t know, I don’t know… I don’t FUCKING KNOW, Frank. I TOLD you not to ask me about Edy, I don’t want to talk about it, I don’t…
JOHNSTON: Joe, if you don’t talk about it you’ll never get past it. I just want to get a full picture of your mental state right now. That’s what I’m here for. I’m not here to make you angry.
NELSON: Alright. Just don’t ask me about Edy, Frank, don’t, please.
JOHNSTON: Tell me about the war.
NELSON: Aw, no…
JOHNSTON: Joe, you’re here because of it.
NELSON: Don’t I know… Well, have you ever seen a friend killed in the trenches right by your side? Have you?
JOHNSTON: No, Joe, I haven’t.
NELSON: Yeah, well that’s clear enough.
JOHNSTON: What do you mean by that?
NELSON: If you had you wouldn’t be the one asking the questions.
JOHNSTON: And I understand that’s when you got the wound in your leg?
NELSON: Paul got it in the heart. Me in the leg.
JOHNSTON: And how do you feel about the cane?
NELSON: Shit, well, it isn’t great to be 23 years old and have a cane, I can tell you that much. And the pain… It hurts like hell, Frank. I’m all balled up, you know? I can’t go back like this. I can’t let her see me like this, oh God, I can’t let her see me like this.
JOHNSTON: Edy. [No response.]
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