Diagnosis: Schizoaffective Disorder

It was the last place she wanted to be, but the one place she knew she should be. It had been three days since Sylvia’s mother had been committed for borderline personality. The young woman had managed to avoid the asylum since then, knowing she would eventually end up in the creaking old elevator waiting to be taken to the floor her mother’s ward was located on. Yet, as is human nature, she preferred to put off the unavoidable in hopes of avoiding it and she had done a fine job at it until that day before when she had gotten the letter. They needed her to fill out some paperwork, and in order to do so she needed to identify her mother for them.

Red painted nails clicked softly against the elevator handrail as Sylvia grasped its splintering surface in an attempt to steady herself. She had never been one for elevators, but the thought of making such a long walk up the stairs, only to stretch out the agony of being in the dreadful institution to see her now-declared-insane mother, seemed like some sort of Chinese water torture. It was only because her hand was so tightly wrapped around the bar that she didn’t fall as the old elevator jolted to a stop with a sharp squeal—the sound of metal on metal. Her eyes flashed up in surprise to find the arrow above the door not pointing at level four, but just below three. She let out a small wheeze, and her hand fluttered nervously to her chest. Checking her nerves, she quickly walked over to the button’s board and began pounding the small blue button that read “door open”. A vibrant ding sent a wave of relief through the young woman as the doors reluctantly groaned open.

Sylvia’s heels sharply struck the ground as she stepped the foot and a half down and onto the ward floor. The first thing that hit her as she stepped from the broken elevator was the wretched smell. It overpowered her senses and for a second she faltered, trying to adjust to the putrid air that seemed to grow stronger and more pungent with every second. The smell of human decay, rotting flesh, and disease seemed to envelope her. It took all the strength she had to stop from gagging in disgust or even fainting in terror. If this was what the whole hospital was like, she wasn’t quite sure what she was going to do. Around her people shuffled, hunched and slow. Some were old and decrepit, their skin wrinkled and hanging on their thin bones; others were younger, yet still their skin, though less worn and wrinkled, also hung loosely on the bones that protruded so sharply from their bodies.

It took the horrified woman a minute to collect herself as she looked at the people so ghost-like, wandering the bleach white halls. Her stiletto heels snapped loudly against the linoleum floor as she began making her way down the long hall. Her eyes darted side to side in a paranoid manner, and Sylvia tried her best to stay away from the lunatics that surrounded her. She jumped to her right to avoid a particularly decrepit looking man as he shuffled by her. His eyes were staring at the tiled floor, and it seemed to be taking all his concentration to speak as he shook his head side to side, muttering, “Ffffffuck da wife.” Another, younger looking man followed the older one closely, his eyes found Sylvia’s and her stomach lurched as he idled over to her.

“I’m tired.” His voice was small, his eyes big. “I—I’m tired.”

Sylvia took a step back from him, and his shoulders seemed to sag. In defeat he shuffled away, whispering the mantra to himself all the way. She quickly continued on, more shaken up than even before, her hands nervously fiddling with the buttons of her pressed white shirt.

“Honey, you look lost?” A sweet voice stopped Sylvia in her tracks. She swiveled around and was met with the smiling face of an aged woman. There was a halo of white fuzzy hair framing the woman’s worn face, and a small white hat with a bright red cross balanced on her head. “How in the world did you end up in this dreadful place? Come now; let’s get you to where you need to be.”

Sylvia gave the elderly nurse a warm smile, “I was beginning to think I was the only sane one on this floor.” The nurse gave a small laugh as they turned the corner at the end of the hall. In front of them was another stretch of hallway.

As they walked they passed by the small cell-like rooms that held the women patients of the ward. Many were out of their rooms at the moment, but some were sitting in the small rooms, most curled up on the straw mattresses that adorned their floors. One woman was standing in the center of her cell, her hands tucked tightly under her arms as she walked toward the wall, but just as she reached it she stumbled backward a few feet and then with just as much determination as before proceeded to walk back toward the concrete barrier. It made Sylvia’s blood run cold, seeing the crazed look that overtook the lunatic’s facial features with its ugly bruises just above the eyes. The nausea had not passed from the overwhelming stench that permeated the air.

The old woman beside Sylvia stopped suddenly. “I know the stairs are here somewhere. I saw them yesterday. Up, no down. Up on left, down on right. Down, yes down to the basement.” The woman gave an extremely pale Sylvia a steely look, “Do you wish to go to the basement?”

Sylvia’s eyes stared into the woman’s, so wide and cold, and a shiver passed through her. “I need to get to the fourth floor.”

“No, the basement, they all must go to the basement.” She gave a short laugh and a toothy smile. Abruptly she twitched, dancing onto her left foot and then onto her right. She continued this wild dance, while bursting into almost hysterical laughter. “They all went to the basement!”

The woman was crazy. Pure dread shot through Sylvia and she stumbled back against the wall, attempting to grip the smooth white walls. She probably would have fainted had it not been for the young woman in the nurses’ outfit that suddenly appeared, rushing toward the hysterical old woman.

“Oh dear! Where did you get that hat from this time? This is the second time in one week. Linda, you must stop frightening the other patient’s.” The nurse gripped the woman’s arm, stopping her dance. “Elizabeth! Elizabeth, please get down here quickly. I need you to escort Ms. Lunabin to her room, and please find out who gave her that hat.”

“Yes, ma’am,” the small nurse said, pressing Linda Lunabin’s arm and leading her away. As they walked away the old woman could be heard stuttering a quiet apology.

“S-s-sorry, I just wanted to h-help her. I-I need to get the-the kindness award!”

The young nurse patted the nurse’s arm kindly, “Yes, yes.”

The other nurse turned back to Sylvia, who was still plastered to the wall. The nurse’s sympathetic look sent slight relief to the young woman and she took a tentative step away from the wall. “I-I’m not a patient. I’m visiting someone.”

The nurse’s eyes sparkled. “Okay,” she replied nodding, “Then let us find your way out of here.” The nurse waved for Sylvia to start down the hall, and Sylvia began to walk, the nurse following closely behind her. “The elevator is just down here.”

“It’s broken. That’s how I ended up on level three when I’m supposed to be on four.”

“It isn’t broken. It is simply temperamental sometimes; it doesn’t always like to take you where you want to go.” The nurse gave a toothy grin just as the two of them reached the elevator doors. Sylvia was surprised to see they were closed. The nurse pressed the up button with her long bony finger and it lit up. A second later the doors groaned open and Sylvia was bustled inside the enclosed box, the nurse pressing the button for level four. “Thank-you for coming, maybe you will come back to visit us again. We all love visitors.”

Sylvia gave a smile as the door dinged, and began to close. The woman smiled back—a crazed smile, and just then Sylvia noticed the drool that was seeping from the corner of the nurse’s mouth. Just as the door’s closed the woman’s hand grabbed into the air and she hungrily stuffed the still buzzing fly between her wretched yellow teeth.

Case Record Folder

Institution: Beldam Insane Institution

Name: Siddle, Sylvia O.

Legal Status at Admission: Involuntary – Parental Control Admission

Date of Admission: February 3, 1966

Sex: F

Color: W

Marital Status: Single

Birth Date: 17 yrs. – July 13, 1948

City of Birth: Walnut Creek

State or Country of Birth: Iowa

Father’s Name: Joe Siddle

Mother’s Name: Tonya Siddle

Diagnostic Impression at Admission:

1. Paranoid delusions

2. Hallucinations

3. Manic reactions

Diagnosis (Mental Disorder): Schizoaffective Disorder

Doctor’s Comments: Dangerous manic moods. Self-destructive- continues to bit nails until they bleed. Tends to wander-under strict observation, please keep. Continue ECT.