The English Patient and the Menninger Clinic in Topeka, Kansas 20 and 25 years later: What happens to the loves that lie within?

Psychology of the English Patient, Psychoanalysis of the English Patient, Topeka Menninger Clinic

I recently experienced two very different trips into the past.  The first was a return to a place and a community that was formative for me personally and professionally 25 years ago – but the physical place where the growth occurred no longer exists, something that I was quite unprepared for.  The second was re-watching The English Patient – a film that I vaguely recalled as a love story – and, though I recalled many scenes and events within it, I did not recall the thread that wove the elements together into a beautiful, if haunting and terrifying tapestry.  It tells the story of the ways in which love, when it has asserted itself, haunts us, even after the person we have loved is gone.

The Menninger Clinic in its Hey Day

I was a trainee at the Menninger Clinic in Topeka Kansas for three years from 1989-1992.  Menninger was then and still is (in a second incarnation) among the premier psychiatric hospitals in the country.  It was then geographically isolated – Topeka is a small city in the middle of the country that is hard to get to - for many years the best restaurant in town was said to be the cafeteria at the hospital - and I liked to say that there was nothing to do in Topeka except study and get well. In fact, it was a place of tremendous growth for the staff as well as the patients.  Because there were few attractions – or one could say distractions – much of the entertaining was done in people’s homes – Topeka is where I learned to cook, and to garden.  In addition to formal education – including classroom learning, supervision of clinical work including testing and therapy, and engaging in research – we formed a book club and spent a great deal of time hanging out with friends – continuing to learn how to be with people.

The English Patient is a film based on a book and I used Norman Doidge’s wonderful psychoanalytic review of it as a teaching device this week.  The book, written by Michael Ondaatje, and the film, directed by Anthony Minghella, tell the story of an interpersonally remote Hungarian Count László Almásy  (Ralph Fiennes) who is powerfully drawn into a dramatic love relationship with Katherine Clifton (Kristin Scott Thomas) , a married woman.  This relationship proves fatal to the woman, her husband (Colin Firth as Geoffrey Clifton) and, ultimately, to Almásy himself, but not before he tells the story of how the love for this woman consumed him – literally caused him to be burned into an unrecognizable shape – and to betray thousands of people including Caravaggio (Willem Dafoe), a thief who has come to find Almásy with revenge on his mind because his thumbs were cut off in part because of Almásy’s betrayal of the Allies to the Nazis.

The point of contact between these two stories – mine and Almasy’s – is an odd one.  We both remain hostage to our earlier love – and work to keep it alive – to stay in contact with it – after it is dead.  Doidge, in his commentary, makes clear that the movie airbrushed two important details from the book that are quite ghoulish – and that separate the two stories –but that may also allow me an empathic avenue into something that I frankly never thought I would have a chance of wrapping my mind around- necrophilia – sex with the dead.  I know that sounds weird, so hang with me a little bit here.

The story of the love affair between Almásy and Katherine includes a shared loved for a famous cave in the desert – the cave of the swimmers.  Almásy takes Katherine to this cave to wait there for him after she is injured when her husband suicidally aims his two seated biplane, with her aboard, at Almásy.  He misses Almásy, but kills himself, and wounds Katherine badly enough that she cannot travel.  Almásy promises to come back for Katherine.  He leaves her with some water and what food he has and walks across the desert to get help, but runs into a war where, as a Hungarian, he is taken prisoner as a presumed enemy; though his sole interest is in saving his English lover.

The movie glosses over that it takes him three years to get free (in the movie it feels more like three days – or at most three weeks - and this is the first airbrush) and, to get back to his now certainly dead girlfriend and to keep his promise, Almásy trades secret routes into Cairo to the Nazis for a biplane to retrieve her.  When he arrives back at the cave, she has died, and the book gives enough hints to clarify to the astute reader that he has sex with her, while the movie has him cuddling with her (the second airbrush) before carrying her to the plane.  As he is returning her body to civilization, he is shot down, and his skin is severely burned.  Saved by Bedouins, he is given to the English – and he pretends to be English and amnestic so that he is not treated as a prisoner of war again.  As the English patient, he ends up in Italy where he is nursed by a woman named Hana (Juliette Binoche) who fears that everyone she loves will die (her father and her lover have died in the war and she has aborted her child, and her best friend is killed by a land mine). This is Almásy's fear as well, though she does not know that.  She chooses to care for someone that she knows will die – the English patient - perhaps as a way to confront her fears.  So they hole up in an Italian Villa where Caravaggio and the crew that undoes mines finds them.

I had gone back to Topeka expecting to find the Menninger campus in disrepair.  It was a big place.  I had seen a film that Graham Rosen had made of the campus where he and his parents, both of whom had been on staff, climbed around some of the buildings and even found some of them unlocked.  I hoped that the buildings would have been better cared for since the film was made.  I was unprepared to find the campus gone. 

Thirty or forty white brick buildings – buildings that had housed hospital units, a pharmacy, the cafeteria, activity therapy buildings where patients worked in greenhouses, at pottery wheels and looms, as well as a gym, simply were no more.  The signature building – a replica of Independence Hall – still stands, but it is surrounded by barbed wire.  Apparently kids had broken in and some were living inside it – and building fires to warm themselves on the concrete floors.  It is boarded up and no longer the proud place it once was.

What had once been a windswept hill in Kansas is that once more – and all of the activity, all of the spaces that held so many lives and around which so many others revolved have been removed without a trace.  Even the parking lots, and the roads, which had once been well manicured and where there had once been gardens at every intersection, were no more.

It was an odd and eerie feeling to be there.  It was a pleasant early Autumn day.  There was a nice breeze and it was mostly quiet except when the sound of the freeway blew in.  It was just the kind of day and just the kind of place that made for doing what Menninger did best – help people slow down and look at their lives and work to rebuild them.

The Menninger Clinic has moved.  The primary reason for that is that health care changed in the 1990s.  Psychiatry was becoming the most expensive component of health care in the US, and long term hospitalization was the most expensive component of that.  At the reunion Saturday night, Walt Menninger stated that they were forced to move because the changing health care environment demanded that a psychiatric hospital be associated with a major medical center, so the hospital joined forces with Baylor College of Medicine in Houston.  Actually, I think that a short term hospital needs to be closer to a major metropolitan area.  When I arrived at Menninger in 1989, the average length of stay at the hospital was just over 2 years (or so, this is based on my sometimes faulty memory).  When I left three years later, the average length of stay was under three weeks.  It no longer made sense for people to find their way across the country to a remote outpost to stay for three or four days to a week.

Now it happens that, right before I went to Menninger, I had been a trainee at the Baylor College of Medicine in Houston.  There could not be a greater contrast between two places than between Houston and Topeka.  Houston is full of sky scrapers and the sky is full of the pollution from the oil refineries that bring the wealth to this hot and humid city that is sixty miles from the Gulf of Mexico, but only sixty feet higher than sea level.  It is flat, flat, flat and criss crossed by concrete bayous that are mostly dry until a rain storm when they are suddenly 10 or twenty feet deep, and you know that you really are living in a swamp – and a dangerous one at that.  In my class of 12 trainees, 7 of us were involved in or witnessed a violent crime during the year of training I was there.

I have not visited the new Menninger campus and, while I am sure that good care is given there – many people that I highly respected made the move to Houston and I expect that the culture of care was maintained – many people did not, and most of the three hundred people who gathered in Topeka were those who did not make the move – some of them staying in Topeka and many of them being scattered to the four corners of the country.

When Almásy returns to the cave where he has left the person who has been most precious to him, he discovers her – mummified – in a dry cool and dark place.  Not unlike the places in ourselves where we store the warm memories of former lovers and former loves – like my love for Menninger. 

I think it is no accident that Ondaatje chose a desert explorer – Almásy is a real person that he totally fictionalized for the English Patient.  And I think it is no accident that the cave of the swimmers is the place for the Reunion with Katherine.  The cave suggests that there was once, thousands of years ago when the aboriginal people made the paintings, water in what is now desert – that this place that cannot sustain life was once filled with it – just as we feel bereft (deserted even) after a lover - who has sustained and nourished us - leaves us – high and dry; or when we discover that our love is gone – the way that I did walking across the windswept hill in Eastern Kansas (as if the empty buildings preserved the place that I knew and loved).

How reassuring it was, then, to rediscover the people that I loved – first at a celebration of Menninger at the Washburn University library, and then at a banquet Saturday evening.  They were very much alive.  And, unlike reunions that I have gone to with people that I knew earlier in life – say in High School – these people that I had known in middle age were very much like themselves.  And the warmth of feeling – the sense of belonging – quickly returned.  It was as if that place in myself that I have nurtured and that has nurtured me all this time really were still there.  Not just the memories of the things that I have learned – which I have relied on as a huge part of my professional identity – but the sense of myself as alive with these life-giving people – whole again in the ways that I was when I was with them (and still am, though with different people sustaining me and being sustained by me).

OK, so I have promised to compare this trip to Almásy’s necrophilia.  That no longer feels so good.  Please remember that Almásy was a really remote guy.  He fell deeply and madly in love with Katherine at least in part against his will.  He did not experience himself as having an affiliation with country or person.  The desert, with its lack of boundaries, suited him.  So did, in that way, the loss of his skin.  He was not a person with a strong sense of being bounded from others, and so his primary means of managing closeness was to withdraw; into his work and into the desert.  Katherine discovered him there – and Geoffrey, her husband, from Almásy's perspective, all but forced her on him – leaving them together in the desert after extolling her many virtues.

Katherine felt to Almásy like water feels to a man who has been dying of thirst, but doesn't know it.  She brought him to life.  And her loss felt like losing that life.  This is similar to my experience of Menninger except that while Menninger augmented my life, it was not the sole source of my well-being as Katherine became for Almásy .  While I miss Menninger and the people there, it really felt good to see them – most of them thankfully alive and well (some have died and some are not doing so well), and it reinvigorated me to be in touch with them.  If I had only been able to find the empty campus on my return, I think it would have evoked very different feelings – a sense of longing for something that might have felt lost and irretrievable - as I'm guessing that Almásy, returning to the cave, felt that he was to discover.  My connection with the people reminded me that the place in my heart where they still live is very much alive.  For Almásy and others who are remote enough that only one person has been able to animate their heart – I can imagine a terrible longing to reanimate the lost person and their love for and from that person when they are gone…

OK, I refuse to end on that note.  This reminds me of a moment with my son when he was very young – about four or five years old.  He said to me, “Dad, I must have a very big heart.”  I responded by saying something like, “I’m sure you do – but what makes you think so.”  He said, "Because you are inside it, and Mom, and Grandmom and people at school and my aunt…” 

Thank goodness for big hearted people with generous love.  And thank goodness that some of them have decided to work with those who have struggled to be able to connect with others.  It really is too bad that a place that allowed that to happen has disappeared, but the spirit that animated that place has been spread broadly (including, I’m sure, to its new incarnation), and we will keep alive the flame of connection – a flame that does not have to burn quick so painfully as it did for Almásy because there are people, like the people I was with on Saturday night, who care for each other and for the people who turn to them for care.  Our memories are of something real that is missing, but still present to us in our connection with those we continue to love who are around us.

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Smith Henderson’s Fourth of July Creek: Antiheroes face the things that most of us do.

I recently posted about The Magnificent Seven and a nonfiction book called Shadow Divers.  The heroes of both the movie and the book were men who were good at using tools and their bodies to solve complex problems.  The heroes in both were not so good at the messy stuff of life – at engaging in long term intimate relationships.  I speculated that their interests – in gun fighting and deep sea diving respectively – might have been propelled by fears of engaging in that stuff.  If they needed any evidence that human attachments are to be feared, they would have found it in this long, complex and deeply satisfying novel.

Pete Snow is a social worker in rural Montana.  The son of a successful but demanding rancher/ financier and the brother of a man who is wanted for assaulting his parole office – the parole officer in this small town is the brothers’ mutual friend in high school - Pete is a long haired blond divorced father of a teen aged girl he named Rachel, and he seems much more concerned about the few cases in his charge than about her.  His genuine concern for Rachel is masked by his hatred of her mother for cheating on him.  Unfortunately it is not just the readers who initially don’t understand the depth of his attachment to his daughter, but Rachel herself does not feel it; and this creates the fulcrum around which the novel turns.

Pete is a guy I both admire and loath.  He is the brightest among his group – his friends call him the professor – and he is probably the best looking of the bunch.  It seems like things have come easily for him – too easily.  Like the high school quarterback he evokes some envy.  But he also evokes some pity – or maybe something stronger – could it be disgust?  He intermittently boozes it up – not just a little bit but a lot.  He is also a do-gooder – someone who goes out of his way above and beyond the call of duty to make sure that his charges get what they need.  All that nobility packed inside so much self-destruction just makes him seem too wired – too hot for me to handle.  I think it would be hard to be friends with him.  Weirdly, then, it is not hard to have him as the hero of the book – which probably means that I am identifying with him.  If you are psychoanalyzing me, feel free to wonder about my level of self-hatred; but don’t forget to include Pete in that – he hates himself, and many of those around him - a lot.  And, as is often the case, he also has a fair amount of self- love and plenty of compassion.  He, like most people, is a complicated critter.

Central to the narrative are the people on Pete’s case load.  We know that this book is an allegory because he only seems to have about five cases and his bosses don’t seem to mind if he is out of touch or out of the state for stretches of time.  Don’t get me wrong, the book hangs together as a tale - it isn’t all that obviously an allegory in the way that something by Roald Dahl is.  Pete is very believable as the harried social worker scrounging for placements and scaring up food and resources in a rural community filled with people who would have a hard time making it if they were in a booming economy - which there hasn't been anywhere near here for a very long time.  These folks are junkies and ne’er do wells and their kids are already headed in way the wrong direction – and how could they not be when some day-old spaghetti washed in hot water and served with ketchup as sauce is the best meal they’ve had in a week?  But there is one kid in particular – Ben is a kid living up in the mountains with his Dad – he is a kid who shows up one day on the school yard lot with clothes that are too big and a nasty case of scurvy – and he becomes the focus of Pete’s interest; And Ben, in turn, leads Pete to Ben's Dad, Jeremiah Pearl.

When Pete returns the kid to his father’s neck of the woods, the father takes the kid back, but returns the clothes that Pete has given him - clothes that actually fit.  He doesn’t want a hand out from the government.  In fact, he plans to take the government down by circulating coins that are disfigured – he punches holes in them so that it looks like the presidents have been shot in the temple and he believes that people will see this and understand that money no longer has intrinsic value – and so will lose faith in the economic system and the whole country will come tumbling down.  The guy is more than a little wacko (a technical term).

In fact, Jeremiah Pearl turns out to be way wacko and way off the beaten path and Pete doggedly, relentlessly pursues him.  As he does this, we vicariously engage with this guy whose wacky thoughts line him up with Timothy McVeigh and the hordes of angry white men who have come down out of the hills and into the voting booth this year.  And he oddly turns out, then, to be Pete’s twin – and therefore, through my identification with Pete, mine.  Wow.  Who’d a thunk that I could identify with a bible belt crazy who has cashed in all his worldly possessions for Krugerrands, rifles and bullets?  The genius of this book is that helps us see the humanity in a whole swath of people who, from a distance, we would write off as living in a world that is unlike ours.  The book Young God takes us to a similar world but the characters that emerge continue to be strange and unlike us – the characters in Fourth of July Creek become quite human (meaning “of our tribe”) and, dare I say, normal under their veneer.

A word of warning – there are no good women in this book.  The closest thing to a good woman is Pete’s daughter, Rachel.  We are introduced to her on pages that bear no numbers in interviews with we know not whom – sort of her, but not quite her – someone who has access to her thoughts, but can also view her objectively.  Eventually we figure out who she is and she enters, at least for periods of time, the central narrative. And when she does enter the narrative, she tears Pete’s and our hearts out – and stomps on them – as she makes one bad decision after another and we – who feel through Pete the depth of his connection to her – are appalled but somehow not surprised as she careens from bad spots to worse.  It is a nightmare – but not Kafkaesque – it is a very American nightmare.  One that doesn’t seem unworldly – in fact it feels far too real.

I must admit to a guilty pleasure that helped me survive the turmoil in the book.  The book is set in the late 70s and early 80s.  There are no cell phones or email.  Files are written on paper.  Everyone is off the electronic grid – and there is a relaxed quality to that experience.  I feel almost like I have gone home.  I have left this alien world filled with too much stuff in too little time.  The lack of electronic messaging mirrors the limited case load that Pete seems to carry.  Both seem too good to be true.  They also allow us to embrace the off the grid experience of Jeremiah and Ben - living without modern interruptions is really quite nice.

Pete’s love for Rachel and Jeremiah’s love for Ben are the glue that hold this book together.  They are actually what help us through some very difficult spots – places that are hard to imagine and yet feel all too real as we read them.  Pete and Jeremiah – Snow and Pearl – are both essentially good – though very flawed – people living in a corrupt and problematic world.  Both rebel against the corruption – especially in the form of authority figures who dictate what is best – and both pay a high price for not toeing the line.  More importantly, they pay a high price not just because of their flaws but because of their virtues – they choose to love – to connect – to become attached – despite knowing full well that the objects of their love are faulty and despite knowing, if not explicitly at least implicitly, that their love is bound to fail.  This is the heroic stance that they take – a stance that we all should emulate and, in our best moments, do.

The traditional heroes, the ones who are stronger than steel, save damsels in distress.  Pete – and Jeremiah in his way – set out to do just that.  Despite their best efforts – or at least the best that they can manage given who it is that they are – they fail.  And they succeed.  One of the beauties of this book is that we are left with a very satisfying sense of uncertainty about the outcome of all that has taken place.  This is a book that left me feeling satisfied – as if I had eaten a full meal – I think because we all survived – and sometimes that’s the best that we can do.        

To access a narrative description of other posts on this site, link here.  For a subject based index, link here. 

To subscribe to posts (which occur 2-3 times per month), if you are on a computer, hit the X button on the upper right of this screen and, on the subsequent screen, hover your cursor over the black line in the upper right area and choose the pop out box that says subscribe and then enter the information.  I'm sorry but I don't currently know how you can subscribe from a mobile device - hopefully you have a computer as well...