The Emigrants

In response to my request, Dr Abramsky described shock treatment in greater detail. At the start of my career in psychiatry, he said, I was of the opinion that electrotherapy was a humane and effective form of treatment. As students we had been taught — and Fahnstock, in his stories about clinical practice, had repeatedly described in graphic terms — how in the old days, when pseudo-epileptic fits were induced by injecting insulin, patients would be convulsed for minutes, seemingly on the point of death, their faces contorted and blue. Compared with this approach, the introduction of electric shock treatment, which could be dispensed with greater precision and stopped immediately if the patient's reaction was extreme, constituted a considerable step forward. In our view, it seemed completely legitimate once sedatives and muscle relaxants began to be used in the early Fifties, to avoid the worst of the incidental injuries, such as dislocated shoulders or jaws, broken teeth, or other fractures. Given these broad improvements in shock therapy, Fahnstock, dismissing my (alas) none too forceful objections with his characteristic lordliness, adopted what was known as the block method, a course of treatment advocated by the German psychiatrist Braunmiihl, which not infrequently involved more than a hundred electric shocks at intervals of only a very few days. This would have been about six months before Ambrose joined us. Needless to say, when treatment was so frequent, there could be no question of proper documentation or assessment of the therapy; and that was what happened with your great-uncle too. Besides, said Dr Abramsky, all of the material on file — the case histories and the medical records Fahnstock kept on a daily basis, albeit in a distinctly cursory fashion — have probably long since been eaten by the mice. They took over the madhouse when it was closed and have been multiplying without cease ever since; at all events, on nights when there is no wind blowing I can hear a constant scurrying and rustling in the dried-out shell of the building, and at times, when a full moon rises beyond the trees, I imagine I can hear the pathetic song of a thousand tiny upraised throats. Nowadays I place all my hope in the mice, and in the woodworm and deathwatch beetles. The sanatorium is creaking, and in places already caving in, and sooner or later they will bring about its collapse. I have a recurring dream of that collapse, said Dr Abramsky, gazing at the palm of his left hand as he spoke. I see the sanatorium on its lofty rise, see everything simultaneously, the building as a whole and also the minutest detail; and I know that the woodwork, the roof beams, door posts and panelling, the floorboards and staircases, the rails and banisters, the lintels and ledges, have already been hollowed out under the surface, and that at any moment, as soon as the chosen one amongst the blind armies of beetles dispatches the very last, scarcely material resistance with its jaws, the entire lot will come down. And that is precisely what does happen in my dream, before my very eyes, infinitely slowly, and a great yellowish cloud billows out and disperses, and where the sanatorium once stood there is merely a heap of powder-fine wood dust, like pollen. Dr Abramsky's voice had grown softer as he spoke, but now, pausing first to review (as I supposed) the imaginary spectacle once more before his mind's eye, he returned to reality. Fahnstock, he resumed, had been trained in neurology at an asylum in Lemberg, immediately before the First World War: at a time, that is, when psychiatry was primarily concerned with subduing those in its custody, and keeping them in safe detention. For that reason he was naturally inclined to interpret the recurrent desolation and apathy of sick patients exposed to continued shock therapy, their growing inability to concentrate, their sluggishness of mind, their muted voices, and even cases when patients entirely ceased to speak, as signs of successful therapy. So to his mind the docility of Ambrose was a result of the new treatment. Ambrose was one of the first of our patients to undergo a series of shocks, over a period of weeks and months; but that docility, as I was already beginning to suspect, was in fact due simply to your great-uncle's longing for an extinction as total and irreversible as possible of his capacity to think and remember.