By Jerome Miller

Two marvelous memoirs - Life Inside and Not the Thing I Was - instruct us that although the cast of characters in adolescent psychiatric institutions may change with the times, the scripts remain pretty much the same. These important books - each tells of life in a premier child or adolescent psychiatric treatment program roughly three decades ago - are valuable for the larger issues they force the reader to confront.

Stephen Eliot is described on the jacket of his troubling memoir as "a successful Wall Street financier." As the title indicates, he is also an alumnus of The University of Chicago's Sonia Shankman Orthogenic School, run by the late famed Bruno Bettleheim.

Recreating Personalities

Bettleheim came to the United States in 1939 from Germany after being confined at both Buchenwald and Dachau. He subsequently wrote a treatise on how the Nazis broke down a personality in the concentration camps, which became required reading on Gen. Dwight Eisenhower's staff.

Bettleheim, with a background in the 1930s European tradition of psychoanalysis and a Ph.D. in art esthetics, was appointed director of the Orthogenic School in 1944. As Eliot puts it, "Dr. B. believed that if the Nazis could create an environment to destroy personality, as they originally intended with the camps, he could build an environment that could foster and re-create personality. Some may say, 'What arrogance!' and yet he did it."

Eliot's book was first published in France under the title La Metamorphose, where it was well received. Scheduled for U.S. release this spring, his memoir provides a somewhat awkward but invaluable insight into the daily functioning of one of the most heralded - deservedly or not - child treatment centers of the past century.

His parents took him to the "Ortho-genic School" in 1963, at a time when, by his own account, he "believed . . . that all the options presented to me were deadly." He was subsequently diagnosed "borderline schizophrenic" and stayed at the school until age 21.

During those 13 years, Eliot experienced the vicissitudes of an autocratic regime. Bettleheim, after overhearing young Stephen refer to the school as "prison," told the boy, "Do you know why you are here? You are here because your parents can't stand you, so don't talk about how much you like being at home." Eliot writes, "I never again said that I wished I was at home or that I missed my parents. I wasn't going to lay myself open to that kind of humiliation."

At times, Bettleheim emerges as a neo-fascist, slapping and gratuitously humiliating selected children and adolescents in his care. At other times, we see a caring, intensely involved, albeit depressed, father, in a Teutonic European tradition of another era.

And yet, despite this ambivalence and his humiliations at Bettleheim's hands - and in contrast to the recent spate of books debunking Bettleheim for padding his resume and misrepresenting what he did - Eliot gives a generous assessment of his mentor: "It is difficult for me, even now, to make up my mind. I think I come down in the end to this: Here was a man . . . who re-created his life and helped make a life for numerous kids who had no hope in hell of surviving on their own. . . . His good and bad traits seem magnified since he did little that was ever halfway."

This is probably not a book for the cognitive therapist or behaviorist. What Eliot describes is too contradictory and unpredictable. The personal involvement, indeed, the passion, demonstrated by staff at the school, for good or ill, would probably keep the hotline to a contemporary child protective services office humming. Bettleheim's behavior is both an indictment of and a credit to his own involvement.

Upscale Institutionalization

At roughly the same time, 15-year-old Mindy Lewis was consigned to the highly regarded New York State Psychiatric Institute at Columbia-Presbyterian Medical Center, a teaching hospital. At the hospital's demand, her mother pressed charges of "truancy," "smoking marijuana" and "unmanageable behavior" to ensure her daughter's commitment as a ward of the state. This prevented her from signing the girl out "in a moment of weakness" and ensured that Mindy remained in the institution until age 18.

Mindy, too, received a diagnosis of "acute schizophrenic reaction" - in her case, "with marked pre-morbid hysterical features." It probably didn't help her situation that she ended her first meeting with her psychiatrist-therapist with "my worst malevolent smile" and a quiet "f*** you."

Lewis' book is beautifully written. Her follow-up in meetings and chance encounters with the central protagonists in the years following institutionalization are particularly moving and instructive. The great strength of her deft narration lies in the glimpses she provides into how this odd period of relative encapsulation changed - often tragically - the otherwise cluttered lives of all involved, be they teenaged patients, families or staff.

For me, reading these fine memoirs suffused the room with a cumulative sense of déjà vu - at once haunting and predictable. Having had a more-than-passing professional and clinical experience with the adolescent and child treatment community over 35 years, I came away with the sense that contemporary psychiatric treatment of children and adolescents is afflicted with a repetition compulsion. It is a world of unresolved themes and chary outcomes.

The same contradictions and vexing ambiguities continue to afflict the contemporary "helping" professional. The same melancholic state of "patienthood" characterizes most adolescent units one sees. Perhaps most disturbing is the routine practice of coupling psychological "help" with threats of coercion. Having thoroughly corroded our handling of troubled and troubling adolescents, this virus has spread throughout the "helping professions," and it is virtually impossible to separate many therapists from the sci-fi "psychojusters" running the world in a creepy H.G. Wells radio drama I once heard.

I surmise that Lewis probably has not read Erving Goffman, but her description of the abiding oppressiveness of the adolescent wards is right out of Asylums (Asylums: Essays on the Social Situation of Mental Patients and Other Inmates; Anchor Press). She writes of the unlocking of doors, the "creepy" shower room, "the white tiles glare" and "lining up for meds" (Elavil, Valium, chloral hydrate), which bestow "flatness, distortion, and lack of luster - my body turns leaden, my mind hums humbly, objects spout halos."

Thug Medicine

While minds have been altered with new psychotropic drugs, the environments that dictate their use haven't altered much at all. Lewis' ability to tap the uncomfortable realities that lurk behind the hospital narrative suggests that either of these dramas can be interpreted in wildly different ways.

Today, as we sanction and commercialize parents' obsessive concerns over their disturbed children, a new phenomenon emerges: The more affluent now can engage teams of "certified" thugs that, at the behest of "accredited" special schools or treatment units, will snatch up an odd or recalcitrant teenager and whisk him or her off to exile in "treatment" programs from Utah to Samoa. In my experience, such frantic actions are as likely to result from parental fears of confronting otherwise forbidden material in adult lives as they are to be stimulated by a child or adolescent's unacceptable behavior. In Eliot's book, these matters are not addressed. Lewis makes a valiant attempt but, ultimately, they elude her.

As a consequence - just as in contemporary psychiatry, psychology, and social work - one is never quite sure whether the diagnoses being used and the treatments being imposed sprang from science, ideology, child development theory, politics or the vagaries of insurance reimbursement. Despite the decades that have passed since these writers were institutionalized, and despite the "happy face" that routinely covers (largely with psychotropic medications) much contemporary psychiatric treatment of children and adolescents, matters haven't changed much.

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