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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