Psychiatric Utopianism

2 Sep

Helsinki was in a second week of mid-winter storm. Dark, hopeless emptiness is penetrating most areas of human activity, the young psychiatrist named Tero Saari said to himself on his ride to the Niuvanniemi Hospital of the Helsinki University Hospital System. He was about to begin a pioneering research project in the Department of Psychiatry there.

His first task was to locate the office of Dr. Aaro Jokinen, the person appointed to be his supervisor. The man’s sympathy and cooperation would be vital to the success of what Tero hoped to accomplish.

With a lengthy effort, the research specialist located where he was to meet with the director of his program. A secretary showed him into the modest office of Jokinen, who entered through a side door after Tero had sat waiting for several long minutes.

The two greeted and shook hands. Aaro Jokinen was a heavy, rotund figure with thinning hair and whitish blue eyes.

When the supervisor was seated behind his steel desk, he got down to important business at once.

“There are many individuals who have doubts about what you can accomplish with your so-called utopian method, Dr. Saari. I have had to listen to arguments from several colleagues who wished this research plan of yours be canceled and not supported. But I succeeded in overcoming these objections.

“I merely wish to relate how unpopular your method is here in Helsinki. You seem to be swimming against the general tide of opinion in the profession of psychiatry.” Aaro Jokinen made a barely visible grimace. “It took a lot of effort on my part to win approval for what you plan to do here. I just wished to inform and warn you. Your new Utopian psychiatric treatment has severe enemies who totally oppose it.”

“I realize that, sir. It was no different for me with my practice in Tampere. There has been no reason for me to expect an easy time here in Helsinki. I am ready for any difficulties thrown in my way.”

The two psychotherapists stared at each other in silence for a short time.

His supervisor wished Tero good luck and dismissed him with a nod of the head. “My assistant will help you set up your group of patients diagnosed with major depression,” he said with a forced grin.

A psychiatric nurse was assigned to assist Tero with the patients assigned to him.

Taika Lahti was a tall, willowy blond with greenish eyes that had a steady, confident gaze to them.

Dr. Saari described his radical, innovative therapy to her in the tiny office allotted to him.

“I wish you to fully understand the theory behind my new approach, Nurse Lahti. That is why I am giving you this general summary report that I sent to Dr. Jokinen when I first applied for permission to carry out additional research here at University Hospital. Let me summarize my main principles for you.

“The idea of a perfect life in a perfect society is, of course, very old. I need only mention Plato’s Republic and the Utopia of Thomas More. It has many times been noticed that a belief in a utopian future affects personality and its possible problems. Look at the history of utopian socialism and anarchism, for example.

“So, I have focused my research interest on the potential effects of fervent utopianism on psychiatric conditions of mental patients. Can the promise of satisfied, perfected life reshape human thought and behavior? That is what I have been attempting to establish.”

“You have met with surprising success in your Tempere practice, I have read,” noted Taika, the psychiatric nurse.

Tero smiled with satisfaction. “It is amazing what happens when you tell people they can be happy all the time, with joy that never ends. That they will never again fall into sadness or despair, but live as members of a new, utopian society. The promise made to patients is one of everlasting goodness and elevation. This will become possible when the one suffering from depression becomes part of a new utopian society and way of life.

“The results of believing such concepts are revolutionary. The new convert feels that nothing will ever go wrong for them under such a new, reshaped world. There are no limits to their confidence, once they themselves become utopians. Even the deepest and most serious depression can be reduced and finally eliminated.

“My goal and purpose shall be to prove this through my research in this hospital, Miss Lahti.”

The latter smiled and her green eyes sparkled, giving Tero increasing confidence in what he was going to achieve.

The next item on the psychiatrist’s agenda was the selection of suitable patients suffering depression who appeared to be appropriate subjects of exposure to and indoctrination to a generalized version of modern utopianism.

Tero, a tall, athletic-looking giant with light auburn hair and grayish eyes, completed over a dozen interviews and went through personal medical records before completing his choices.

Which personalities seem the most open to new ideas that promise alleviation of pain and a final cure? Who seems to be a good candidate to becoming a true-believer, a dedicated and fervent utopian?

“I shall be formulating a sort of primer for these chosen patients,” Tero informed his psychiatric nurse. “We are authorized to move them into the same suite of individual bedrooms, so that they will be forming a shared group as much as is possible. I hope that the result will be that each of them inspires and encourages all the others who are involved.”

That evening Tero received a electro-call at his apartment. Could he come to his supervisor’s office early the next morning? There was an important matter that Aaro Jokinen wished to discuss with him as soon as possible. No mention was made about what this subject might be.

The following day, Tero went to the University Hospital earlier than usual, showing up at his director’s office before the administrator appeared for work. Aaro ushered him into his private area and the pair sat down opposite each other. “How is your program progressing?” he asked the researcher.

“Quite well,” replied Tero. “I will soon begin to meet and consult with the patients that are in the group.”

Jokinen furrowed his large, hanging brow. “There is someone I am waiting for. He has told me that he wishes to speak to you personally, in a private place like my office.”

“Who might the person be?” asked Tero with aroused curiosity. Before the director could give an answer, there came a knock at the door to the office.

“Come right in,” said Aaro in a loud, ringing voice that had a hint of hidden fear under it.

The man who entered was short, with a large head and a thick mane of silver hair. He strode forward with self-assurance, his almond eyes fixed on Tero.

“This is Dr. Saari,” said Aaro to the man Tero had never seen before. “This is Dr. Heino Jarvi, he is head of our professional ethics and practices committee for our Department of Psychiatry. Please take a seat, Jarvi.”

The little man sat down facing Tero, parallel to the steel desk of the director.

“I shall allow Dr. Jarvi explain the problems that have arisen around your present research program,” announced Aano, turning his face toward the man he was talking about.

Heino Jarvi spoke in a high, sharp tone, as if in some psychiatric court of law where he was prosecutor.

“Several serious questions have surfaced about the ethical acceptability of what you propose to do at our hospital, Dr. Saari. Let me summarize the difficulties that you are presenting to my committee on professional practices.

“You plan to begin your study with six patients that you will name. They shall all be indoctrinated with the identical maxims and principles of a perfect, utopian social system and culture. That in itself contradicts our rule of tailoring treatment to the individual illness of a patient. If the same principles and beliefs are taught and inculcated in all six of the subjects, then that similarity will negate any claim to personal treatment or attention. What you plan to do would handle each patient as if there were no differences in the nature of the depression that they suffer from.

“My committee and I find that situation completely unacceptable and unjustifiable. Such ignoring of individual differences is not the way that psychiatry has been allowed to evolve under medical standards.

“Another objection that has been raised is the unreality of what is promised to the patient if they accept the new utopian belief system presented by you. As far as anyone can determine, the ideas offered to them are pure fantasy, more fiction than present-day existing reality. In other words, you are fostering an imaginary fraud, an abnormal dream upon disturbed minds. That is neither ethical nor professional, Dr. Saari.

“Therefore, my committee and I are recommending that University Hospital halt your project and forbid any further meddling by you with he care we are giving to the mentally ill.”

A deep and uneasy silence fell over the office. It was Aaro Jokinen who broke it.

“I think we all have to think about what has to be done.” He turned his white blue eyes on Tero. “For now, your program will be in temporary suspension.”

Dr. Jarvi was the first to rise and leave without a further word. Then, Tero did the same.

Taika was appalled by what Dr. Jarvi had done.

“Ever since I came here to work, I have shivered at the mention of that character. There is something about the mere sight of him that makes me feel sick inside. What is it about him? The man is a careerist. There is nothing he would not be willing to stoop to if it might forward his position in his profession.

“He is the direct opposite of what a psychiatrist ought to be. Heino Jarvi cares only for his own selfish advancement. In this case, he means to elevate himself by degrading and humiliating you.”

Tero felt the force of her greenish eyes focused directly upon himself. After a short pause, the nurse spoke again.

“There is something that I have to tell you about the patients selected for the project. I have seen and spoken with all six of them, announcing that the utopian therapy has been abruptly ended. They are, all of them, startled and angered by the news. They cannot understand why that was done, and I could not give them any adequate reason for what is happening.

“All of the patients have placed their hopes on you and your new method. From what they have been told about utopianism, they have come to believe and trust in it. Their disappointment at the suspension is grave and profound.

“Three of them whispered to me that they wish to go on, despite the decision made, with what has been started. If utopian treatment contains the slightest chance of successful cure of their state of depression, they wish to continue with it. That is what they secretly revealed to me in private.”

Tero did not say anything for a time, as if unable to locate the right words for what he felt. Unidentified emotions welled up at the center of his being.

“I am justified, I believe, in continuing to see each one of the six patients. What we talk about is our business. There has been no prohibition on my having informal conversation with any of those unfortunate souls, is there?”

“Not at all,” murmured Taika in a muffled tone. “Not that I know of.”

Both doctor and nurse understood that the program of utopian psychiatry was going to go on behind the scene, a forbidden and banned activity.

A few days later, Dr. Jokinen summoned Tero to his office again. He had a critical bit of news to tell him.

“The matter is going to reach its climax. Dr. Jarvi has brought serious charges against you and wishes to have all your privileges taken away. A hearing will be held before his committee and he will outline the specific charges against you. His aim is to expel you completely from the legal practice of psychiatry. He means to stamp you as an unethical experimental who endangers the welfare of patients by recruiting them into a fantasy-based cult of utopianism. He means to sacrifice you to his own ambitions up the ladder, I am afraid.”

“The charges against me are false,” asserted Tero vehemently. “I aim to disprove them before this committee.”

Aaro frowned. “Do not underestimate the man, Tero. He is a devious player and has no mercy in him. You are going to be sacrificed for his own individual good, he thinks. The fellow is sharp and devious. He knows many tricks and is willing to use them against you.”

“But I will have the truth on my side,” said Tero under his breath.

The day for the Ethics Committee meeting arrived in the course of time, quicker than anticipated by either Tego or his opposing accuser, Dr. Heino Jarvi.

It was a simple, fairly small conference room in the administrative wing of the University Hospital’s Department of Psychiatry. The person under moral indictment, Tego, was the first to appear there. He had to wait in patience while Aaro Jokinen, the committee members, and finally Dr. Jarvi rushed into the chamber and took his seat at the main table. The latter immediately opened the proceeding.

“It is best that we begin our business at once,” he began, standing on his feet among the sitting committeemen.

“We will first present the outstanding charges that have been brought against Dr. Saari. Let me read to you a brief summary of the separate points that have been specified as infractions of the psychiatric code of ethical conduct.”

He looked to each side of the table in turn, then looked down at the papers in his hands and started to read. In a droning voice, he slowly pronounced each word and sentence with careful attention.

The sound of the door opening came to those listening to the indictment. They looked to see who was entering.

It was the psychiatric nurse called Taika Lahti who stepped in first. But then she was followed by a second figure, one dressed in patient’s clothing. A third individual, then a fourth one followed.

Heino Jarvi stopped speaking, gazing at the group of intruders. In the rear of the conference room now stood Nurse Lahti and the six patients who had volunteered for treatment within the experiment in psychiatric utopianism. The entire contingent of therapeutic subjects were there along with the nurse who had been assigned to them.

The general confusion that prevailed ended when Taika began to address everyone who could hear her.

“Please excuse us for appearing here unannounced, but it is most important that this committee hear what we have to say before it comes to any judgment about the program of Dr. Tero Saari. I have assisted in preparing the patients who are part of this exercise. Their experience should be known to your committee, because it reveals the truth about his actions and methods. I request that you permit each of the patients to describe the nature of their relations with Dr. Saari. If there are any questions in your mind, these people are ready and eager to answer them. This process will not take a long time, and I am certain that you can come to judgment and decision today.

“Shall we, then, proceed?”

Heino Jarvis was unable to block what now unrolled before the ethics committee. All of his colleagues unanimously voiced their shared opinion of agreement. “Let us hear exactly what the patients have to say,” said one of the psychiatrists on the committee. “Please proceed, Nurse Lahti. We all want to hear what their experiences with Dr. Saari were like.”

One-by-one, the men and women who had come in with Taika had their say, answering all the separate questions that came from the investigating committee.

“There was nothing harmful done to us by Dr. Saari, whom all of us like and respect.”

“I have never received anything so helpful and satisfying in my years of therapeutic treatment. My chronic depression has started to decline. I believe that psychiatric utopianism is the best method that has ever been applied to my sorrowful case.”

“It is a shameful crime that Dr. Saari is put under a cloud of accusations. He is a good, dedicated doctor who only does good things for those under his care. No other psychiatrist in this hospital, in Helsinki, or all of Finland, can compare with his faithfulness to his profession. I and all the others can swear to that.”

So went on all six of the participating patients.

It gradually became clear to Tero that he was going to be proven innocent of all the charges against him stemming from Heino Jarvi.

When all the patients were finished, an unexpected proposal came from Aaro Jokinen.

“I suggest that we dismiss all accusations and charges,” he called out in an uncharacteristically loud voice. “This circus has gone on long enough. It is time to put an end to such nonsense. Does everyone agree?”

A muffled affirmative noise was audible all along the long table.

Heino Jarvi could do nothing, say nothing. No alternatives were left to him. He had been defeated and he knew it.

The patients speedily exited, as did Nurse Taika Lahti.

Tero watched as the committee members filed out, as did his supervisor, Dr. Jokinen.

A dirty, hatred look came from Dr. Jarvi as the little man made a slippery, snakelike egress.

With a smile of happy victory, Tero went forth to continue as the Finnish pioneer of utopian psychiatry.

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