A PSYCHIATRIST’S 1ST LESSON IN VIOLENCE, by Art Smukler, author & psychiatrist

My training as a psychiatrist started when I was two. It was dark and I was standing in a crib screaming my lungs out. No one heard. No one came. No one gave a damn. Not being heard and not being understood has shaped my life.

Twenty-six years later, on July 1, 1969, I entered Philadelphia General Hospital (PGH), an ancient medical fortress located at 34th and Spruce Street, to begin the first day of my three-year psychiatric residency. Residents from Drexel University School of Medicine (back then it was called Hahnemann Medical School), Jefferson Medical College, and The University of Pennsylvania School of Medicine shared the responsibility for treating thousands of inner city, mentally ill patients. I got off the elevator at the third floor, walked down the dimly lit hallway, and stood frozen staring at the ten-foot-high metal door that led to the locked psychiatric ward. Four years of medical school and a year of medical internship did not prepare me for this moment. Nothing could have prepared me for this moment. Finally, I pushed the entry button.

“Who is it?” a scratchy voice asked through the speaker above my head.

“Art Smukler, one of the new first year psych residents. There’s an eight a.m. meeting.” What if when she buzzed open the door, I simply turned around and left? I’d find a phone on the first floor and explain my grave mistake to the chief of psychiatry. A friend had mentioned that there might even be an opening in Internal Medicine right here at PGH.

“Okay. Come in and close the door immediately behind you.” The door clicked. I sighed and stepped inside. What struck me first was the gloom; a grayness hung in the air and obfuscated any attempt for color to inject life into the wide hallway lined with offices on both sides. The only visible window was way down at the other end of the hall, maybe a hundred feet away. Were those bars across it? Dust particles swirled and danced in the muted light, little molecules that I was inhaling. Was Schizophrenia contagious? Of course not. Nevertheless, I held my breath for an extra few seconds. My next breath was tinged with the odor of urine. A skinny, gray-haired man, six feet tall, bald with a week’s worth of facial stubble, shuffled towards me — tiny steps, jerky and lacking any fluidity. His washed-out Temple University sweatshirt was three-sizes too large and his baggy jeans were wet in the crotch. His face was fixed-and-rigid and dribble oozed down one side of his mouth. As he shuffled, his thumb and forefinger on both hands rolled rhythmically against each other. I turned sideways and let the man pass. What was I thinking when I decided to become a psychiatrist? A tall, stately, latte-colored woman wearing a beige sweater and a knee-length brown skirt, holding a metal chart, stepped out of a doorway and literally blocked my way. Not so hard since I was half plastered against the wall.

“You’re Doctor Smukler, Doctor Arthur Smukler,” she said with authority. Her hair was pulled back in a tight bun, each strand fully captive.

“Yeah. That’s me.”

“Fourth office on your right.”

“The meeting room?”

She nodded.

“Who are you?” I asked.

She stared me square in the eyes and didn’t break eye contact. I didn’t either.

Finally the woman answered, “Lena, the head nurse.”

I unplastered myself from the wall and extended my hand. “Pleased to meet you, Lena.”

After a few long seconds, Lena gave me a quizzical look and her hand grasped mine, a warm, firm grasp.

“Is something wrong?” I asked. “Something I’m missing?”

She sighed and pointed down the hall. “Room 304, Doc.”

“…Thanks,” I said, and had the distinct feeling she wanted to add something, but thought better of it. Was there a secret to all this madness? As Lena disappeared into the nursing station, an elderly woman with waist-length, disheveled, blond hair with graying roots, approached. She fluttered her eyes provocatively and hissed like a wild cat. Frozen, I nodded hello, and forced myself to keep walking.

A few feet further down the hall, a middle-aged man, black-hair greasy and matted, stood against the wall. His arms were folded tightly across his stained, gray T-shirt, his eyes frozen in place, staring at nothing. As the hair on the back of my neck stood at attention, I walked straight ahead. The schedule called for a full day of orientation before we would take over our new duties. Little did I know what was in store for me…

To read the complete novella, The Man with a Microphone in his Ear, PLEASE CLICK TO YOUR RIGHT on the cover.

7 thoughts on “A PSYCHIATRIST’S 1ST LESSON IN VIOLENCE, by Art Smukler, author & psychiatrist

  1. My grandmother, an immigrant from Italy, was taken to Marcy State Mental Hospital in the early 1930s where she remained except for holiday and summer visits till she died in the early 1970s. Think of what that place must have been in the early days of psychiatry. I only learned in the last month that the diagnosis was schizophrenia. I only hope she had, at least sometimes, a kind, gentle doctor as Dr. Smukler showed in the “Man with a Microphone in his Ear. I am now 65 and now I shed tears for her.


  2. I imagine that’s the way C.G. Jung felt when he first walked into the Burghoelzli mental institution in Zurich, Switzerland, in 1900 for the first time! Whoa. The Man with a Microphone in his Ear–intriguing title!


    1. I think you’re right. Initially, mental illness can be very scary. The usual controls that we all have are missing when someone is overtly psychotic. Dr. Jung and Dr. Smukler… I like the sound of that. Thanks!


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