CR3 #27: Crazy All the Time: On The Psych Ward of Bellvue Hospital by Dr. Frederick Covan

In the early 90s, Dr. Fred Covan was the head psychologist at New York’s busy Bellvue Hospital. Bellvue, of course, is where all the “crazy” in NYC eventually lands–where the doctors make their best efforts not necessarily to cure, but to at least help. It is a fast-paced environment, and anything can happen at any time.

During the year detailed in the book, Dr. Covan is advising a group of young residents, assigning them each to a variety of patients, and attempting to teach them how best to handle each situation that arises. The residents are a diverse bunch: male, female, rich, poor, black, white, Hispanic, traditional, and radical. However, they are drawn together by their desire to help those who are unable to help themselves. Some of them struggle more than others. Some get too attached to their patients, others can’t find a way to identify. They find their patients difficult, frustrating, and heartbreaking. Most of the residents eventually realize they are doing a thankless job that will never be done.

The book sounds depressing, but it is actually quite funny. Many of the patients are both pathetic and exceptional, and the residents’ reactions to the patients’ misbehavior can often be hilarious. And of course at every turn the administration is there to make life tough for everyone, whether be a shortage of Rorschach tests, a total lack of pencils, patient secretaries that either won’t type or don’t have time because they are wiping down every visible surface, or endless “diversity surveys” that do nothing but take up valuable treatment time. I even ran across the enemy of hospital admin workers everywhere: JCAHO — the hospital accredation body, who exist solely to make sure every piece of paperwork that drifts through a hospital has its Ts crossed and Is dotted.

Sometimes, it becomes hard to decide who is sane and who isn’t…though rollerblading naked through the streets, swallowing razors, and a self-inflicted pinking shear penectomy (go look it up–I’ll wait) are certainly good indicators of disturbed psyches. There is a long and very interesting section about defining what is normal and what the goals of psychology should be. One resident argues that the goal is to make a schizophrenic patient take all her meds until her delusions go away–by committing her if necessary–while Dr. Covan argues that the goal is to allow her to function as best she can out in society while not being a danger to herself or others. It’s an interesting debate.

The book is definitely a good read–it’s well-written, fast-paced, interesting, and sometimes emotionally challenging. I’d recommend it to anyone who is interested in mental health work, or is just interested in a great story.


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