Patricia Langston

Duration: 56mins 45secs
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Interview with: Patricia Langston
Interviewed by:
Dates: January 14, 1975
Archive Number: OH 098

LM: Interview with Patrician Langston, January 14, 1975. Ms. Langston, how long have you been a psychiatric nurse?

PL: Well, actually—technically, I suppose—I started in 1972, November 1, but I’ve been around psychiatric problems since about the age of 12 because my family started a nursing home here in Houston at that time. So I was reared around—you might say—having close contact often with alcoholics and drug addicts and geriatric patients, which now, of course, are very prominent—figures very prominently in the psychiatric scene.

LM: And where are you working now?

PL: The psychiatric unit at Memorial Hospital downtown.

LM: Have you held any other positions?

PL: Yes, I worked for TRIMS, Texas Research Institute of Mental Sciences for a year and a half.

LM: And what were your duties there?

PL: Well, actually, I was hired in clinical research with drug addicts and alcoholics, and then later I was on the general psychiatric floor as the 3:00-11:00 charge nurse.

LM: What kind of problems did you run into?

PL: Well, primarily it was drug abuse and quite a few psychotic patients. We usually got the patients from Jeff Davis Hospital, so they were pretty rough.

LM: All your cases were referred from other hospitals?

PL: Some were direct referrals, but most of ours were pretty rough and tumble.

LM: What do you mean by that?

PL: Well, because they would come in from Jeff Davis, oftentimes they were very disturbed and they would have to be placed in seclusion rooms quite often. They resented authority, and they were agitated or hostile. Sometimes we would have patients that would attempt suicide, so there would have to be a lot of close observation. It was not like having a ward full of neurotic, middle-aged women.

LM: What was the major disorder that you came into contact with most?

PL: I would say schizophrenia.

LM: Were most of your patients—well, let’s put it this way—from what social strata did most of your patients come from at TRIMS?

PL: At TRIMS? I would say at TRIMS that it was generally the middle or lower class, with an occasional sprinkling of the upper class.

LM: Sex and age brackets?

PL: I would say it was primarily more younger people. It seemed to me like it was fairly equalized between male and female.

LM: What was the ratio composition?

PL: It was pretty well integrated. But of course, again, coming through Jefferson Davis Hospital, the psychiatric unit there, to TRIMS, we did have more, I’d say, than average of the black population, as a result of that. If we were in a private institution, I would say that it would be as it is at Memorial downtown. It would be more white—Caucasians.

LM: What was the rate of commitments from the referrals that you received? Do you have any idea?

PL: Yes, it was quite high at TRIMS. I’d say it was 50 percent plus.

LM: What was the major reason for the commitments?

PL: Well, sometimes the reasons for that would be rather obscure. Sometimes you would actually suspect that maybe the family wanted to just remove them out of the way for some particular reason. This can be done. As a matter of fact, your neighbor can have you committed. And this is an aspect of—for instance, if you get a couple of physicians or psychiatrists to agree to this—you might have a slight inducement in one form or another—you could get a person committed. But oftentimes it was for irrational behavior or perhaps some physical abuse or bizarre behavior of some type. But every once in a while you’d get a person in there that perhaps there was a love triangle involved or something like this, and you perhaps had some doubts.

LM: 06:17.7 From what you just said, it seems that it’s relatively easy to have someone committed.

PL: Very easy.

LM: Well, what are the rules?

PL: Well, someone could go down and file a complaint and have someone sent to Jefferson Davis. Like I said, they offer—or you would hear—you could either sign the commitment papers, where you then would become incarcerated for 90 days, or you can go through a hearing. And they urge you—the person—really not to do that, but just go ahead and voluntarily sign it. So that’s the usual procedure. Most people will go ahead and sign and commit themselves to 90 days. And once they’re committed, if the doctor would believe that the patient is improving, he can discharge the patient before the 90 days.

LM: Where are they committed for 90 days?

PL: Where?

LM: Uh-hunh (affirmative).

PL: Well, to any psychiatric institution—to Austin State Hospital or TRIMS or Jefferson Davis or some other place.

LM: I thought only the longer commitments were referred to the state hospital. But even the 90-day commitments can be sent there too?

PL: Generally, yes, they can be committed to Austin.

LM: You mentioned before that—or indicated—that some of the doctors might be induced to commit someone by relatives. Was that a correct assumption on my part?

PL: Well, I really don’t have any basis for that, but observing what I have among psychiatrists, I would say that that is very possible, because many of them are lacking in ethics and principles.

LM: 08:33.4 Can you be a little bit more specific about that?

PL: Well, it’s actually, in my opinion, generally—now there are some exceptions—but generally, the psychiatrists treat with the phenothiazines, which are drugs like Thorazine and Stelazine and drugs that are related like that. They spend perhaps 5 minutes with their patients a week. They’ll just come in and say, “Well, hi, how are you doing? Did you have a nice weekend pass? Well, oh, I’m so glad to hear that.” And they’ll go on, you see? They’re really not— They do not seem to be that interested in their patients. And because there is this lack of interest, you question their motivation. And perhaps if they could be induced to—by money perhaps, if the occasion rose—

LM: Do you know of any occasions where that happened?

PL: No, that would be very difficult to— No, I do not.

LM: What is the—? What are the procedures when a person first enters the hospital? He’s just been referred there, and he’s entering.

PL: Well, he comes in, and he’s orientated to the unit, which is usually very brief.

LM: What do you mean “oriented to the unit”?

PL: Well, for instance, like the rules and regulations and what time meals are served and telephone privileges and merit system ratings and this sort of thing. Like for instance, if you make your bed, we’ll give you five merits which can be five slips of white paper, and as you collect these, you can buy things with them. Things like this, orientating them to the system. And then, there are usually, upon admission, we will receive doctor’s orders and medications are begun. Then they get into the regimen. For instance, group meetings or rap sessions or occupational therapy. At certain times every day there is a routine, and then if they are good and do not create any waves, so to speak, then the doctor may give them a weekend pass. So this is the way that they function. So actually, the physician relies very heavily on the word of other people because he normally spends very little time with the patient. And the content of their conversation is usually very shallow, like I said, “Well, did you have a good weekend pass?” “Yes, Doctor, I did.” And the patient is setting there and wondering what complex thoughts are going through the doctor’s mind. I’ve had some doctors, on occasion, ask me, “What do you think I ought to give this patient?”

LM: Doctors have asked you that?

PL: 12:15.3 Have asked me, “Well, what do you think I ought to give this person?” I said, “Well, you’re the doctor. Well, what do you think about a little Thorazine 25mg q.i.d. four times a day?” “Well, that’s good. I’ll start them out on that.” And he’ll write it out. On one occasion I heard a doctor actually ask a patient what she’d like to get. And of course, I’m sure they’d have some very good answer for that. Some psychologically oriented question, knowing that doctor as I did. He was really asking what would she—and that was just it. There wasn’t any complexity to it. He was just simply asking.

LM: Now are we talking about TRIMS still?

PL: Yes.

LM: Okay. I want to keep it separate from what you’re doing at Memorial.

PL: Yes, we’re still talking about TRIMS.

LM: What is the doctor/patient ratio at TRIMS?

PL: When I first got there, there were two physicians—two psychiatrists—for a patient load of about, I’d say, 65. And then, as usual, there was a turnover in the administration. This doctor came in there and he brought in a bunch of his buddies. It’s a very politically oriented institution. So now I would say that there are about—oh, I can’t say exactly—but I would say that there are at least 20 psychiatrists active on that staff.

LM: You said it’s a politically oriented—

PL: Very. It’s very— It’s got a lot of political overtones or undertones or whatever you want to call it.

LM: Can you give a specific example of what you mean?

PL: Well, it’s just in the operation, or running, of the institution. You can just— I don’t know. It’s difficult to be specific about that. It’s just simply in the operation of it. There’s a lot of pressure, and there’s a lot of backstabbing and trying to get ahead up the ladder and the political hierarchy, because it is run by the state. It’s a state institution. It’s very important. The spirit of competition is very, very strong.

LM: 15:05.5 How are doctors appointed to the hospital?

PL: I really couldn’t tell you except that the one that was head of it, I do know that he brought in a lot of his friends.

LM: Does the hospital have outpatient treatment?

PL: Yes, they have an outpatient hospital. They also have a halfway house, where patients are recommended for this outpatient—or halfway house. They live there and they get their medications there and they go out for the day and work. Then they always return there. Of course, your so-called better patients are recommended for the halfway house.

LM: What is considered a “better patient”?

PL: Well, one that has more potential for recovery or functioning in society.

LM: What is the procedure for someone who goes to TRIMS with a problem and he thinks he can’t handle it and he wants help? Is he helped?

PL: Generally, I would say no. He goes in there, and generally he’s hit with medications. If he doesn’t take them by mouth, he’s given injectables. If he’s unruly, he’s thrown in seclusion. Now, if a person goes along with the rules and regulations, well then eventually they’ll get out. But I’d say that if they are better when they leave, it’s because they are so happy to be out—(laughs)—that it really brightens them. But as far as the actual treatment doing much good, I would not say that it does as much good as the general public is led to believe. It’s generally a bunch of words. Very sophisticated information is being fed to the public to create an impression of awe. And when you get right down to it, it’s just not like that.

LM: What is the treatment the drug addicts receive?

PL: Well, it varies, of course, with the doctor, but generally they are placed on substitute drugs which they become addicted to. It’s a substitution system. They’ll tell you about methadone, or Dolophine, which on a heroin addict they substitute. But we had a case just recently. I suppose you heard it on the TV, about this overdose. I believe it was in Austin or San Antonio or some state hospital where—

LM: 18:38.3 Waco, wasn’t it?

PL: Waco, where a patient or two patients had expired—had died—because of an overdose of methadone, which is of course used as a substitute for heroin. So what they do is they substitute one drug-addicting agent for another. So actually, the patient is still dependent.

LM: Are a great many drug addicts processed through there?

PL: Oh, yes. They sure are. And of course, drugs are coming in there all the time. It is a locked unit, but marijuana is often found and pills of all sorts—Quaaludes and others—so you really need a staff to observe what’s going on. We’ve had patients come in with drugs in their shoes or in their underwear or things like this. So a patient—a drug addict—up there, it’s very easy for him to get drugs. And of course, if we observe the patient and we see that the patient has OD’ed—overdosed—well then, we can collect urine for drugs and see what the patient has actually gotten a hold of. But many times I have found marijuana on a unit. And when the police officer comes up to collect it, he cannot file charges against the person that possessed it as long as they are in a psychiatric institution. He doesn’t even want to know who it is.

LM: Are the drugs being smuggled in through the patients?

PL: I couldn’t say for sure, but to my knowledge, no, it’s primarily through friends or family. However, I have known of cases of employees protecting the drug addict by, for instance, voiding—or urinating—in a specimen cup for the patient so that drugs would not show up in their urine. And there have been employees dismissed because of being drug abusers themselves.

LM: What is the quality of the personnel below the nurse and doctor level?

PL: I’d say it’s rather poor. Many of them, however, have had a fairly good academic background, but I find that, particularly at TRIMS, you have many persons that do not have any respect for life or authority. They resent authority. And many are black and they are militant and they will defy the nurse’s orders. They will go and they’ll do what they want to, or they’ll be very disrespectful. I have been threatened several times by black employees, and I’m not prejudiced by any means, but I have been threatened. And when you report it, you’re told there’s really not anything you can do because they’ll call in the EEOC or the NAACP or something like that. And once they get in, you can’t get them out.

LM: 23:06.8 How were you threatened?

PL: Well, one night when I was getting off—of course we have narcotics that we have to check off—there was this new employee who was a friend to the night supervisor who was black. And when we were signing off for narcotics—well, see, this is very important because the off-going nurse must sign and the oncoming nurse must sign to make sure the count is correct. Well, I went ahead and we checked it out and I signed and she refused to sign. She said, “I’ll sign it later.” Well, it started off that she was 30 minutes late on the unit. And I asked her when she came, “Did your car break down or something? Did you have some trouble? You’re a little late tonight.” And she snapped back at me and she says, “Well, you’re lucky I’m here at all,” very sarcastically. So we counted, and she said, “Well, I’m not going to sign it now. I’ll sign it later.” And I said, “I need you to sign this now because I have already signed it.” “I told you I’m going to sign it later.” She said, “I’m tired of you.” And she had her finger and was shaking it in my face like that. She said, “If you don’t leave me alone, I’m going to really fix you.” And—you know—just making little threats like that. Of course, this is very unnerving, particularly when it’s really not warranted. But they do what they want to, they say what they want to, and oftentimes things are going on in the unit that they refuse to tell another white person.

LM: Such as?

PL: Well, for instance, like the behavior of a patient that they have observed that would be important for you to know to relate to the physician. I remember in particular an incident about one of my patients on my unit that went to the other unit and started a fire in a wastepaper basket. And I was not told that this had happened, yet one of my personnel—black—knew about it. And the other nurse on the other side was black and she—you know—so I just heard by word of mouth through one of the other employees. This sort of thing that creates a very bad impression, because the next day they’ll say, “Well, didn’t you know about that?” And I said, “Well, nobody told me.” Well, that doesn’t sound very logical. But nevertheless, those are things that happen.

LM: What is the relationship between the patients and the assistants? What is the term for the people who are employed beneath the nurse?

PL: Mental health workers.

LM: Mental health workers.

PL: 26:33.8 Well, it varies, of course, with the individual. But generally speaking, it’s the haves and the have-nots. The haves, of course, have the authority and the power. They can throw the patient in seclusion, or they can say that the patient did thus and so and get them in trouble. And of course, the patient is at the employee’s mercy, to a certain extent.

LM: Does this happen often?

PL: Well, that’s just the general—that’s just the way it is. But I would say that generally they treat the patients fairly well. There have been instances, of course, where there maybe some over familiarity. When we have little dances and things, the black employees will be dancing with the white patients and then perhaps date them after they get out, or perhaps meet them on a weekend pass.

LM: What is the policy of the hospital regarding relations between the mental health workers and the patients?

PL: It’s not supposed to exist. After their discharge, that’s something else. But you have fraternization between personnel and staff sometimes, between all racial backgrounds—white with white and all sorts of combinations. However, sometimes I really—you know—this is rather in poor taste. It’s against the hospital policy, but it does go on.

LM: What about the doctors who are employed there? Are they residents or are they established psychiatrists? How much training to do they have when they arrive?

PL: Well, they’re established psychiatrists. You do get a few that are brand new, but generally speaking, they’re all established.

LM: Go back for a moment to the outpatient treatment. For the person that merely wants consultations or to talk with a psychiatrist about a specific problem, is this type of service offered?

PL: Well, of course, in their day hospital. It’s more or less that the heavy—or what they consider heavy—treatment has already been accomplished, and they are sort of winging on their own. They just come in there for reinforcement and encouragement, and there is a psychiatric nurse there on the unit. And of course, the doctor is there some, but primarily it’s light; it’s already on the lighter side, or else they would not be an outpatient.

LM: 30:29.9 Being a state institution, is it under state supervision? Are there inspectors who make regular visits?

PL: Yes. Well, of course, it’s involved with the accreditation program and all of that. From time to time, we would have people coming through there, but not that often. But I’m sure it would be regulated by the state because we receive the funds from the state.

LM: You mentioned before that some persons might be committed by relatives that simply wanted them out of the way. Have you seen any instances in which a person wanted to get out for this reason? Does he have any recourse—legal recourse—if he has no help from the outside?

PL: Well, once those papers are signed and everything, he’s more or less at the mercy of the physician. There have been cases where, if you’re a voluntary patient and you are in there for 10 days, you might be able to get out before the 10 days if you contact an attorney. But generally, if you’re committed, that’s it until someone—until the doctor releases you.

LM: Are they allowed to make outside contacts—use the telephone, for example?

PL: Yes. That depends on the doctor, but generally, unless they are very, very bad, they can use the telephone and write letters and things. But I’d say generally the type of patient that comes in there—most of them are really not wanting—are not that desirous of help—either committed or noncommitted.

LM: They’re not really seeking any help?

PL: Not really. Not as far as really trying to find a purpose in living. Some drug addicts come in there to break their habit so that if they’re on a $200-a-day habit they can get off of drugs and start back where it doesn’t cost them as much money. They just start back at zero. It takes them a while to build back up to a 200- to 300-dollar-a-day habit. Some people come in there because they just want to gain their equilibrium so that they can go back on their job. But as far as long-term goals and things, most people are really not—you might say—sighing and crying over the situation.

LM: What led you to leave TRIMS?

PL: Well, there was a personal endeavor that I wanted to do for about 3 or 4 months. I calculated where I had my funds available. But had I not had that, I would have left there anyway because of the political overtones. It was just very nitpicky. It was just sort of a power struggle going on among the medical director and the director of nurses and everybody. Everything was always in an uproar and that sort of thing. It was just not pleasant working there. I used to enjoy it, but it got to where it was not very enjoyable. It was just a big game as to who was going to wind up with the cream puff.

LM: 34:50.5 And where are you employed now?

PL: Memorial Hospital downtown.

LM: And what are your duties there?

PL: Well, I’m working on the 11:00-7:00 shift in the psychiatric unit. And this is a private institution. In this particular instance, they use a great deal of electroshock therapy for their treatment. That’s their prime thing. TRIMS didn’t use that. They were more drug oriented. So I’m just a charge nurse over there.

LM: Does the Memorial unit hold long-term patients? Or what is the length of time that the patient usually stays there?

PL: Oh, I would say probably less than a month, something like that. Longer cases would be maybe 2 months. But they take less of an agitated—they take less agitated patients. It’s a relatively open unit.

LM: How do you contrast the type of patient that you met at TRIMS with the ones you meet at Memorial?

PL: Well, at TRIMS they’re usually more aggressive. They have more bizarre behavior. It was a locked unit, and at Memorial it’s an open unit. It’s fairly structured, but it’s still open. They do not take the same type of patient. It’s more of a quieter environment. Like I said, the treatment is different there; they use shock therapy. Most of Memorial’s patients come in with the diagnosis of depression, whereas at TRIMS it was more like psychotic reaction or schizophrenia or something of that nature.

LM: What about the social strata of the patients at Memorial?

PL: I would say that they’re more in the middle class or the upper class.

LM: How would you contrast the quality of treatment between Memorial and TRIMS?

PL: 38:02.6 Well, at Memorial it’s more subdued, but I would say that it’s the same thing. The majority of people that come there are really not looking for answers. It’s more or less because their husband wanted them to come in or their daughter or something of this nature. There are very few people really looking to find an answer about themselves, even among committed patients. Committed patients are not there because they’re looking for help; they’re in there because someone else has put them in there. And generally speaking, the patients in psychiatric units are just there because someone else wanted them to be there, and they get so tired of being there that they seem to be better by the time that they get out.

LM: What is the—? You mentioned that at TRIMS the age of the patient is relatively younger. What about at Memorial?

PL: It’s older. You have more middle-aged persons, depression, mid-life melancholia, and you have your usual homosexuals and things like that. Of course, the psychiatric association considers homosexuality as perfectly normal now.

LM: Does Houston have an adequate number of resources for a mentally disturbed individual? Do you feel that they receive adequate attention?

PL: I believe that the most benefit for a psychiatric patient is really derived through social service, not through a psychiatrist. I’m talking about the social worker that will aid a person—say for instance—that has had problems in finding a job, referring them to vocational rehabilitation or seeing that they’re put in some sort of training program or seeing that they’re put in a halfway house where they can have a somewhat protected environment. These are some of the best results I have seen, coming from that area rather than coming from the psychiatrist.

LM: Are there an adequate number of trained social workers?

PL: Oh, I’m— Well, at TRIMS they did. They did more along those lines. But at Memorial, I noticed on the charts that very few had even social histories on them. So I feel like TRIMS is superior in that respect.

LM: What is the attitude of the psychiatrists in general?

PL: Well, generally I would say that they have a very permissive attitude. In other words, if a patient came to them, and whatever they were frustrated about or had anxiety about, well then they would tell them, “By all means, if you hate your husband, you go and tell him that you hate him.” In other words, whatever it is that gives you pleasure or release, you should do it. If you want to be a homosexual, by all means, go out there and do it. If you want to commit adultery, that’s fine.

LM: 42:42.1 They actually tell patients this?

PL: They don’t actually tell them that directly, but they are more or less given the impression that whatever it takes to release the anxiety that you have without creating major problems—that they should go after this. So in other words, they have an attitude of, “Well, whatever your thing is, go and do it. If that’s what it’s going to take to make you happy, by all means, pursue it.” So their attitude is extremely permissive, and they’re sort of like tickling the person’s ears, giving them or saying to them what the patient wants to hear with no restrictions on self control or anything like this. It’s almost as if no moral barrier was there at all—or ethical barrier—which seems rather strange in being from an ethical area, so called. There is very little structure, if any—very little structure. For instance, at a seminar I attended recently, there was a prominent psychiatrist there. The subject matter was sexual deviations, major and minor divisions. And among the minor divisions they had listed bestiality, promiscuity, and incest. And they actually said that it’s a normal progression towards adult sexual maturity for two siblings to have sexual intercourse. So this would give you an idea of what their attitude is. And this is a rather dramatic statement, if you really stop and think about it, to classify these kinds of things as minor. And the major aspects were rape, masochistic/sadistic relationship, and pedophilia, which is you have an adult male with a young boy and sexual violation. And they said that there actually was nothing wrong with these things, except to the victim—the psychological trauma that occurs to the victim. But that, in itself, there was nothing wrong with it. So when you really think on these things, you can see the depth of— You might think of it as moral decay, which is reflected in the attitudes of persons today—the permissiveness, the lack of structure.

LM: You mentioned earlier that the majority of patients treated at TRIMS were youthful. What provisions are made for the elderly?

PL: Actually, the elderly are subjected to longer periods of hospitalization which could very effectively be handled in a nursing home. These patients—the majority of them, I would say—there are a few exceptions that I have seen, but generally speaking, the elderly, or geriatric patient, is simply senile, which is a normal occurrence of the aging process. Their mind just simply does not function as well. They’re suffering from arterial sclerosis—hardening of the arteries. And these patients are kept there, and the physicians keep signing their Medicare recertifications and collecting money—keep collecting money. And then, when this time is over with, they transfer them to a nursing home after they’ve gotten all of the time that they can get out of it. Then the psychiatrist, who does nothing for the patient, puts them on a few tranquilizers. The facilities for geriatric patients are very bad also. They need chairs with overbed tables to keep the patient from getting up and breaking a hip. They need someone, oftentimes, to spoon-feed the patient because the patient has forgotten how to feed themselves. Many times they are incontinent of urine and feces. There are really not adequate facilities in a psychiatric unit to take care of these geriatric patients. And from a psychiatric standpoint, they do nothing for them, except the psychiatrist signs the recertification so they can keep collecting the money. And nursing homes could very well have these patients many days earlier than what they get them. There was one case just recently that the doctor kept his patient in the psychiatric unit, and the patient fell. He had a pacemaker. And within a day, he had to be transferred to the intensive care unit in the hospital. And then after he got back from the intensive care unit, the doctor immediately transferred him to a nursing home. When the patient got to the nursing home—I followed up this patient—the patient, who was in his late 70s, had a huge fecal impaction. And when the fecal impaction was removed, the patient slept like a baby and has been doing very well since. So that’s just one example, and there are many, many similar examples.

LM: 50:10.6 Are you familiar with the—? Have you had many dealings with the nursing home care and nursing homes in Houston?

PL: Well, yes I have, since I was a child. I’m also a licensed nursing home administrator in the state of Texas. And nursing homes generally have come a long way. Many physicians today still do not realize the value of nursing homes in the community. They are equipped, really, to take care of many needs of the patient. They can give them intravenous therapies. They can take care of their many urinary problems, as far as catheterization and things like that. They can work with Levin tubes, where they can feed a patient through a tube going down into their stomach. They can take care of paraplegics and quadriplegics and many things—respiratory therapy, occupational therapy, recreational therapy, all of these aspects you see. They’re totally integrated. Medical record librarians, they have access to clinical laboratories, and all of these things—registered dieticians. And they are very well equipped to handle many of the medical problems, including many of the geriatric patients that are in psychiatric units.

LM: Are the nursing homes in the Houston area adequate? Do they give—?

PL: Yes, and you may be surprised to know that a patient that’s in a psychiatric unit—the billing to Medicare will be anywhere between 50 and 70 dollars a day. But in a nursing home, that patient receives the same care, and in most cases better care, for around 14 dollars a day.

LM: 52:45.5 And the quality is—?

PL: Is better.

LM: Is better?

PL: You have a higher ratio of personnel. You still have your licensed personnel—your RNs and your LVNs—the same as in the hospital, except you have a higher proportion of personnel. Actually, it’s required by the state.

LM: Do you have any other—? Are there any other areas you would like to discuss before we conclude the interview?

PL: No, I think that I’ve said everything that would be—that I’ve wanted to say here. I think there are a few psychiatrists who are very sincere in their endeavor to help people. They have a lot of compassion and consideration. But generally, I think that, like I said, they have a very permissive attitude. You have a spontaneous recovery element in psychiatry anyway. About 60 percent of your patients would recover whether they saw a psychiatrist or not, but this is something that many people are not aware of. There are a few that I have seen dramatic improvement, but then you never know; would they have improved anyway without the doctor? But I think that most of your help comes from the social service elements. And sometimes I think there’s a strong psychological effect that the patients receive by having to pay a large sum of money to a psychiatrist, and it has a very definite psychological effect.

LM: On behalf of the Houston Metropolitan Archives Research Center, I’d like to thank you for your participation in the project.

PL: You’re welcome.

(End of interview 55:32)