Mind Games

Once the double set of barred gates slammed behind me with a loud, steely clang, I knew that I had descended into the nadir of New York. Because I had entered the interim home of homicidal maniacs and assorted rapists, as well as arsonists, street thugs, and other felons who comprised this toxic human stew.

Welcome to my new world of work, New York City’s famous Bellevue Hospital, and its more infamous psychiatric prison ward. Situated on Manhattans’ east side, the prison ward was bounded by the East River on one side, and the Medical Examiners loading bays (replete with bio-hazard dumpsters) just across a narrow street. The location was as grim and foreboding as if it was created in Hollywood, a true film noire streetscape. Bleak on the brightest of days, this street was even more isolated at night.

The flow of white sheet clad corpses, strapped to gurneys and off loaded from ambulances were being wheeled into or out of the morgues harshly lit, though somewhat discreet, entrance. And some of these unfortunates were, ironically, the handiwork of the prison wards occupants, now living right across the street. Combined with the darkness of the river front, working late nights at Bellevue was always frightening. Of course, and once I was told about a psychiatrist who mysteriously disappeared on this very street a few years earlier, never to be heard from again, I became hyper alert every time I left, or for that matter, entered, the prison ward.

Yet, and despite its macabre atmosphere, the prison ward fulfilled a very specific need in the criminal justice system. The purpose of the Department of Correction guarded facility, known to insiders as ‘N-O 2’, was to evaluate criminal defendants. Were they legally competent to answer the charges against them, and to participate in their own defense? Were these simply criminals playing mind games to avoid prison, or were they in fact society’s most vulnerable? A team of psychiatrists, psychologists, social workers and case aides worked together in order to probe and poke patient/prisoner psyches to try to find out what really made these guys tick. This is called forensic psychiatry, the crossroads where the disciplines of law and medicine meet.

The staff interviewed, tested, observed and assessed their prisoner/patients in order to reach the right decision. And the stakes here were high, damned high. For the defendant, a finding of ‘mental disease or defect’ usually meant a quick transfer to a civil mental hospital, the bonus prize being that they could expect to never be indicted, nor stand trial, for their crimes.

For the truly psychotic, the legit crazies, they do need the meds, care and custody that civil confinement in a mental hospital provides. Also, it keeps them off the streets. But, and for the gamers, the real psychopaths, this meant that they had perfected their crazy act just enough to ‘get their ticket punched’. Because once transferred to a hospital setting (no guards, just nurses), and after a hot meal or two, these folks would ‘elope’-that means escape to you and me. Free to once again hit the streets, they were ready predators on the prowl…

To say that I entered into this service with the highest and most humanistic ideals, of protecting the mentally ill, would be very noble. It would be great if only it were true. The reality is that, having just graduated from college, being newly married and waiting for my Army enlistment to begin in just under a year, I needed a pay check. While almost anything would do, I had absolutely no more taste for the rigors of manual labor. No, I had done that, struggling every year to meet my tuition payments. I wasn’t about to lay any more pipe on city streets, or cut carpets in a warehouse on the midnight shift again. Yet, I knew, and so did the prospective employers who interviewed me, that I just wasn’t the corporate type. Besides, why would anyone invest in a guy like me, someone who was going into the service soon, possibly never to come back?

Finally, and since I had no other prospects, I shuffled into one of the city’s seedier employment agencies, the kind of operation where the employee pays a fee to get placed. I suppose that I wore my desperation as well I did my ill cut suit. Because just as soon as I had signed a contract promising to pay a fee of one week wages, I was told about a case aide position at Bellevue. Though the pay was low, it was a full time job, and included benefits. And, since I was going into the Military Police, this could be just the kind of on the job training I needed.

The August heat was suffocating, and a bleached sun seemed to only accentuate the murkiness in the air. To save carfare, I walked the mile plus across town to Bellevue. A complex of tired red brick buildings studded with large, grey concrete columns, I quickly noted that the second floor of ‘Psych’ was fully barred. As I entered the lobby, my sweaty clothes clung closely to me, and the sauna like feeling was accentuated by the buildings total lack of air conditioning.

The lobby was dimly lit by several naked light bulbs housed in an old chandelier, and a marble staircase led me to the second floor. Timidly, I approached the bullet proof window set in the steel door, and a guard peered suspiciously out. When I gave my name, he scanned a list and, since I was expected, unlocked the outer door. As he then opened a second, barred door with a large key, he bellowed ‘one on the ward’. For my entire time on the prison ward, this was the standard greeting, day in and day out.



After being interviewed by a social worker and psychiatrist, I was offered the job. I suppose that I appeared sane enough, and had the basic ability to perform preliminary investigations, gather records, and prepare reports. At its best, I saw myself as part of an investigative team helping to ferret out the malingerers and professional criminals from the truly delusional. At its worst, I would also need to provide the patients with ‘concrete services’. This meant that I would have to track their welfare payments, deal with their relatives, make sure that they had writing paper and stamps, and etcetera. Really, I shouldn’t have been surprised that, as the least professional of the staff, I would have the most patient contact.

As the interview wound down and we agreed on a start date, screaming and yelling came from the locked ward near the office we were sitting in. The jangling of keys and handcuffs also mixed with the sound of running feet as about a half dozen guards sprinted down the hallway. It was then that I saw a middle aged black man with a huge afro, clad in a light blue and not too clean hospital issued jumpsuit. He was hopping around, yelling at the top of his lungs-and for very good reason. It seemed that another inmate had just flicked a lit cigarette into his hair, and his head was now alight with orange flames and sputtering yellow sparks.

Quickly, the guards threw a wet towel over his head and then tackled him to the ground. As he thrashed about in both pain and rage, a squat white uniformed nurse waddled over and injected him with what I soon came to learn was the juice of choice at Bellevue, the aptly named powerful drug, Thorazine. He soon lay still, and the guards then directed their energies towards the cigarette arsonist.

While I could have walked away from this grisly scene never to return, I was as fascinated as I was repelled by what I had just seen. This was the theatre of the absurd plus, and I now had a ringside seat.

So it went, the passing parade of the legion of the damned; condemned either by illness or by evil. And I came to know them, much more than I wanted to. There was the teen that butchered his parents while they slept but now sat in mineral silence, absorbed in a very private world. There was the hit man, a contract killer who seemed nice enough. The skyjacker who relished his notoriety and became more grandiose the more media coverage he received. And there were the others, those who believed in conspiracies, poisoned radiator pipes, and a variety of very imaginative ways to kill in seeming self defense.
I even got to meet the Mad Bomber, a middle aged bachelor who planted bombs in telephone booths to get even with Con Ed.

So it went, every day on N O2 was interesting, and sometimes even rewarding. Working in a nightmare garden of the violent and the deformed, it was always edgy, very edgy. Not only did you need to try and clean your mind of other peoples’ mental garbage at the end of the day, you also had to watch that you didn’t get sucker punched or have a pen jabbed in your eye while on the ward. When my orders came through and it was time to leave, I had had just about enough of Bellevue and all of its contortions. I had gotten the pay check I badly needed, met some great people (staff) and came away with what can best be described as a rather warped sense of humor. Something that was to prove invaluable in the Army.

I’ll never forget Bellevue’s chief psychiatrist, who once reminded us that, try as we may, we would never really know what went on behind closed doors…and that the human mind was the densest door of all.