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Dr. Enoch Callaway, Emeritus Professor of Psychiatry at University of California, San Francisco, has written a memoir that is frank, witty, and humane. The author recalls his years from 1948 to 1950 as a resident in psychiatry at Worcester State Hospital, one of the nation's first state hospitals for the mentally ill. In a series of colorful vignettes, Callaway reflects on his personal experiences at this unique institution and evaluates the various treatments of the mentally ill from his time to the present.

Founded in 1833 as the State Lunatic Asylum in downtown Worcester, the hospital was renamed the Worcester State Hospital in 1877 when it moved to a larger building designed according to the progressive ideas of Thomas Kirkbride. Treatments changed over the years, but the nineteenth century structure of WSH remained nearly unchanged when Callaway arrived. (The original building downtown was renamed the Temporary Asylum for the Chronically Insane, and continued to be used even in Dr. Callaway's era.)

Callaway describes the impressive baroque architecture of the massive main building constructed of thick reddish stone, with an imposing clock tower and barred windows. He terms the place a "prison," but also a "fortress" protecting the patients from the outside world. A kind of self-contained city, the hospital included a 500-acre working farm providing therapeutic labor and food for over 2,000 patients, and 1,000 employees. However, only thirty of them were physicians.

The author recalls the warm camaraderie of his peers who literally were residents as most lived in hospital quarters. Living and working together 24 hours a day enabled them to exchange ideas and compare observations in ways hardly possible for today's residents. Callaway also shared his professional life with his wife, Dorothy, who lived with him in a hospital she initially experienced as threatening and repulsive. He expresses loving admiration for Dorothy as she comes to realize that most patients were more sick than harmful. We learn that the mentally ill suffer both the agony of their disorders and the pain of a society fearful of even the most harmless deviancy.

Callaway stresses the advantages of treating mental patients in a protected setting, but admits the limitations of mid-twentieth century psychiatry, noting that the few medications available at the time would now be considered "laughably inadequate" compared with the many powerful drugs of today (5). Lithium for bi-polar disorder, SSRIs for depression, Risperdal and Thorazine for schizophrenia, Buspar for anxiety - all were then unknown.

In Callaway's years at the hospital, schizophrenics endured a 90-minute coma as part of insulin shock therapy. Schizophrenia remains a baffling, debilitating disorder, but today's antipsychotic medications, replacing insulin shock, provide more hope to those afflicted with the disease's paranoia, grandiose delusions, and painful hallucinations. ECT (electroconvulsive therapy) is today a respectable therapy for profound depression, but Callaway makes clear that today's "civilized procedure" of ECT hardly resemble the crudely administered electric shock treatments of the past (28). A procedure he always considered "The Last Resort," lobotomy, now completely abolished, no longer permanently mars the mind and spirit of the victims of this brutal psychosurgery (31).

The author derides his generation's unquestioning enthusiasm for Freudian psychoanalysis, still a debatable methodology never wholly proven effective through empirical evidence. He describes his colleagues and himself "laboring with unbounded, and equally unfounded, faith in the psychoanalytic approach ... while ware-house-like rooms filled with deteriorated patients who defeated our best efforts" (6). His failures still haunt him, e.g., the schizophrenic teenager he failed to help despite her urgent pleas to "make the voices stop" (84).

Callaway remembers, too, his successes—some achieved by luck—including the remission of a seemingly damned schizophrenic whose disorder vanished when he accidently viewed his wildly disheveled self in a hand mirror. He recalls cases when patients clearly improved under his treatment, no longer requiring hospitalization, but concedes they may have improved on their own. He takes pride in the voluminous research done at the hospital, but also recalls that patients were not required to give informed consent.

At times, Callaway appears ambivalent. He describes Worcester State as "a model mental hospital circa 1950 ... a safe house where they [the patients] can recover" (6). However, regretting the many hopeless patients confined to grim back wards, he also characterizes the place as "a snake pit," the title of a film (1948) that grimly depicted life in a mental institution of that period (6).

Remembering inspiring role models, Callaway writes admiringly of Hudson Hoagland, founder of the Worcester Foundation for Experimental Biology, a prominent research center famous for developing the birth control pill. He recalls a visit from the distinguished psychoanalyst, Frieda Fromm-Reichmann, the model for the skilled psychiatrist in Joanne Greenberg's novel, I Never Promised You a Rose Garden (1964). He chuckles, remembering how Dr. Fromm-Reichmann's gentle, empathetic techniques proved so impressive that after her departure the residents unconsciously affected slight German accents. We come to understand that the practice of psychiatry is as much a healing art as a technical science.

Hospitalizing mental patients in an asylum may be viewed as a way of protecting society from the mentally ill. However, as Callaway notes, such hospitals also serve to protect vulnerable mental patients from the criminal justice system. Deploring today's tendency to reduce hospitalizations, Callaway regrets how frequently victims of serious mental illnesses end up in prison or in the streets—drug addicted, mired in squalor, viciously brutalized.

He looks back to a time when mental hospitals like Worcester State safely provided thousands of patients with compassionate care, and sadly reports that the hospital he knew became "a charred hulk" when a fire destroyed most of the original building in 1991(xvi). He can take heart that a new Worcester State Hospital, scheduled to be completed in 2012 at a cost of 302 million dollars, will serve some 260 adults and 60 adolescents.

Unfortunately, Callaway makes factual errors. Contrary to his claim, Worcester State Hospital was not the first state hospital in the country, nor was the Worcester Foundation for Experimental Biology ever moved from Shrewsbury to Worcester. The hospital famously satirized in Samuel Shem's The House of God was Beth Israel Hospital, not Massachusetts General Hospital. Callaway makes only passing references to Gerald N. Grob's The State and the Mentally Ill: A History of Worcester State Hospital, 1830 - 1920 (1966) and to Joseph Morrissey's The Enduring Asylum (1980), two good sources for the history of the hospital. Nevertheless, Asylum is valuable in vividly revealing the personal experiences of a resident in psychiatry and the state of institutional psychiatry in mid-twentieth century America.