Bellevue Hospital, looking over the East River, on 26^th Street, is 7 miles from Rikers Island, adjacent to La Guardia Airport, and prisoners with severe mental disorders will often move from Rikers to Bellevue when they need assessment or hospitalization. Elizabeth Ford worked for many years at Bellevue, most recently as Director of Forensic Psychiatry. Sometimes Amazing Things Happen: Heartbreak and Hope on the Bellevue Hospital Psychiatric Prison Ward tells the story of many patients she has treated. It is a difficult population to treat, partly of the severity of their problems, and partly because the system is largely controlled by the Department of Corrections and is often not primarily aimed at helping the people with mental illness. At one point in her job there she decided she was burned out and she quit, but not long after she was rehired at a higher level. But even then, she spends a lot of her time interacting with patients and sorting out problems that are often more practical than psychiatric. The culmination of the book comes with Hurricane Sandy, when the whole hospital lost power and the building needed to close down but no one else would take their patients. This left Ford and other administrators the task of working out what to do, and how to keep the patients safe. It’s a dramatic story.

Most of the book focuses on the personal challenges of working with a population with severe mental illness and legal problems. They are often angry, uncooperative and making things worse for themselves. The challenge is exacerbated by the presence of prison officers who are frequently unsympathetic to the prisoners and will provoke them. There are sometimes stories of officers hurting prisoners or arranging other prisoners to beat them up. So there are few cases of dramatic improvement and none of full recovery.  Chapters are short and offer a glimpse of life rather than a detailed analysis. While Ford doesn’t say much about her personal life, she does discuss her experience as a pregnant women interacting with prison officers and prisoners, and conveys some of the difficulty of balancing her job with her family life.

While there are some cases here which do have a reasonably good outcome, the unstated message of Ford’s book is that the goal of improving the lives of people who have mental illnesses and have committed crimes has basically been abandoned, and psychiatry has become mostly just a tool of the system of punishment. It is disappointing that Ford does not reflect more on what a person with her job can do given the limitations of the position, and to what extent it inevitably leads to moral compromise. Maybe it would be cause political problems for herself in her current job as Chief of Psychiatry for Correctional Health Services for New York City’s Health and Hospitals, but it would have been instructive to learn of other approaches, maybe in other countries, that have a greater success rate, and who don’t focus so much on punishing people with severe mental illness.

© 2017 Christian Perring

Christian Perring teaches in NYC.