Joanne works nights, so when she said she could only talk at 1 a.m., I wasn’t surprised. Nor was I inconvenienced. Quarantine offers little incentive to wake and sleep with the sun; I was ready for a late-night chat.
I’ve known Joanne for almost three years, during which time her stories about work have intrigued me without fail. Joanne is a psychiatric nurse at Framingham State Hospital, a government-run facility for patients with chronic mental health conditions.* Many of Framingham’s patients spend months or years inside. Some are committed by courts; others self-admit.
Framingham is a virtually closed world. The facility offers no emergency services; it isn’t a place that might receive someone at imminent risk of suicide. Nor does it offer care to patients who are physically, rather than mentally, ill. So, in these pandemic days, when self-containment is the goal of all, Framingham seems exceptionally well-positioned.
But as soon as Joanne and I got on the phone, I could tell something was wrong. COVID-19, she said, had hit the hospital hard. More than 90 of her coworkers had tested positive, as had hundreds of patients in the mental hospital’s many wards.
As a result, life inside Framingham shifted dramatically. Patient housing was completely reorganized to make space for two new units — one designated for COVID-19-positive patients and another for those who refuse to be tested. To equally distribute the risk of infection, hospital leaders removed staff members from the units where they typically work, instead placing them in a rotation of all units (including the COVID-positive and COVID-possible ones). And medical professionals from the Military Health System were called in to provide new, rigid structure for this facility in flux.
But, Joanne says, none of these changes has brought about as much strife as the introduction of PPE, or personal protective equipment.
Just as news of COVID-19 entered the mainstream, Joanne and her fellow nurses began wearing protective gowns and full-face masks (which, Joanne notes, have caused some sort of mutant acne in her nose pores). But soon after the staff began suiting up, a surprising order came down from hospital leadership: “Stop. The masks are scaring the patients.”
When Joanne shared this news with her friends and family, most were, like me, shocked. We had been assured that masks were the key to safety (nay, survival) in workplaces like Joanne’s, where the daily tasks of feeding and bathing patients make close physical contact unavoidable.
But hospital leadership had a reason for its counterintuitive order — and it was something bigger than face mask fright.
Framingham, like many mental institutions across the country, was experiencing something that’s been recognized only a few times throughout history, a phenomenon I’ll call “synchronous delusions.” Patients throughout the hospital, typically entrenched in their separate psychic realms, had begun to experience delusions about the same thing: infection.
Though pushback from doctors and nurses ultimately caused hospital leadership to backpedal on its order, a bit of wondering is warranted. What made Framingham’s leadership so afraid that they were willing to risk the lives of their employees? And what do we risk when the disparate minds of Framingham come together?
To answer these questions, and understand the power of delusional minds united, we must first understand how those minds operate apart.
No single illness is dominant at Framingham. Many patients exhibit complex, comorbid symptomologies — hallucinations, paranoias, fantastical obsessions — for which traditional diagnostic language offers few helpful descriptors. What unifies these distinct cases is a phenomenon doctors generally call delusion: a blurring of the outside and inside worlds.
Some of our clearest insights about delusion come from the foundational texts of psychology — specifically, one of Sigmund Freud’s most expansive case studies, of a “delusional” man named Daniel Schreber. In that case study, published in Freud’s 1911 book “Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia” — whose contents are just as pithy as its title — Freud forwards a simple model of the non-delusional, neurotypical mind: It is insulated, keeping the inside world in and the outside world out.
Freud goes on to explain that between these two worlds lies a boundary, a mental membrane, whose impermeability is the hallmark of the sane mind. It allows us to clearly see the limits of our reality: Unlike our thoughts, the outside world is something we see, not something we generate.
That isn’t to say that neurotypical people aren’t affected by the outside world. On the contrary, the tragedies and traumas of external life constantly attempt incursion. But, when confronted with these triggers, we are aided by a series of defenses, fortifications for the threatened barrier between in and out. We rationalize, or repress, or joke — anything to keep the outside out.
The difference in delusional minds, Freud says, is simply a more permeable membrane between in and out. Delusionals experience a freer flow of outside realities into the self — and a readier projection of unconscious life onto the waking world. In other words, what’s inside the delusional patient — her fears, hopes and traumas — can manifest around her, making it difficult to separate mere thoughts (“I am afraid of monsters”) from truths (“There is a monster standing before me”).
The content of these delusions is highly individual. Upon walking into the psychiatrist’s office, one patient may see the doctor himself, while another sees Jesus in his place. And on the way out, the first patient may bid adieu to a pleasant waiting room nurse, while the second perceives a winged Siren singing tunes of temptation to the wayward patient-sailor. These differences are the product of an individual’s mental life — the paranoias and traumas, fears and dreams, which are uniquely hers.
That’s why it’s startling that Joanne has noticed synchronicity.
Joanne told me that one Framingham patient, a middle-aged woman named Amy, has eschewed her long-standing pattern of delusions — a revolving door of grandiose past lives — in favor of a new obsession with tracking down the coronavirus vector. Paul, a patient whose near-catatonic depression has long rendered him indifferent to reality, has begun reacting violently to the television, which he regards as a pathogenic entry point. Some patients theorize a grand conspiracy, a fictionalized pandemic used by the governments of the world to control their unruly citizenries. Others resist interacting even with their nurses for fear of instant death.
The halls of the mental hospital, once discordant, have begun to ring in euphony — like a tuning orchestra unifying at once around the piercing A of the principal oboe. For hospital leadership, this reality is understandably striking. But it isn’t unprecedented.
The 1950s were a decade of American exceptionalism. In the precarious days of the Cold War, the United States touted its model of “free,” free-market democracy — a system of government that was superior to the subversive communism of the Soviets and their ever-growing bloc.
So, on October 4, 1957, the country received a shock when the Soviet Union launched Sputnik 1, the world’s first artificial satellite. The New York Times called this feat of innovation a prestige triumph for Russian communism, and politicians lamented the beginning of the end for American hegemony. The public panicked, insisting that the U.S. government divert much-needed domestic program funding into the creation of a new space program and the fortification of an already massive military apparatus.
This panic leaked quickly into mental hospitals. Although the so-called insane asylums of the 50s weren’t known for consistent or accurate recordkeeping, many medical professionals remember a reality similar to the one Joanne describes today: an uncanny alignment of disparate minds, an episode of synchronous delusion.
One explanation for these shared panics is that, if delusions are based on an individual’s internal fears and drives, both crises touch on a fear shared by all. Fears of illness, loss of loved ones and death seem like perfect candidates.
But that explanation doesn’t account for the uncommonness of synchronous delusions. The last 60 years have seen innumerable crises: AIDS, wars in the Middle East, even an attack on America’s biggest city. None of these — let alone the more silent, statistically deadlier threats of cancer and obesity — have prompted episodes of synchronous delusion.
What, then, places threats like Sputnik and COVID-19 above the rest?
An article by Wayne Pines, a former FDA bureaucrat, argues that both Sputnik and COVID-19 have exposed fundamental gaps in the United States’ dominant institutions. In Sputnik’s case, it was our nation’s defense apparatus, capacities for research and science education standards. Today, we see the weakness of our health care institutions and the inadequacy of our system of disaster readiness — the dark-room committees and secret security missions that we imagine must be scattered across the government’s nameless agencies, planning for something precisely like this.
We all count on these institutions to make us feel secure. Delusional patients do the same. But when these institutions are upended, finally exposed for their fallibility, a truly fundamental fear is triggered.
In the mental hospital, when one stimulus is powerful enough to breach all patients’ mental membranes, successfully invading everyone’s internal worlds, synchronous delusions are the result.
But I’d argue that something like this happens in the outside world, too.
Joanne has worked at Framingham for more than 30 years. In that time, she says, she’s seen it all. Tasks that would feel foreign to the average person — inspecting, restraining, observing patients while they sleep — are quotidian to her. Psychotic behaviors we might consider incomprehensible are, for Joanne, like a second language.
Because Framingham is a chronic facility, Joanne has known many of her patients for years — longer, she says, than she’s known her own kids. Some patients have been there as long as Joanne has. Some even longer.
Over the years, Joanne has learned a lot about these patients — what good and bad days look like, which family members they miss, what holidays they love. She knows which patients want cookies on Christmas and which want brownies, and she adjusts her holiday-season baking orders accordingly.
Joanne sees her patients’ illnesses as separate from their personalities and intellectual capacities. She knows they’re people. So when she began to understand that an episode of synchronous delusion was unfolding at Framingham, she wasn’t too surprised.
“Of course my patients are all delusional about the pandemic,” she said. “We all are.”
Sure, we’ve all seen the news stories about survivalists and supermarket robbers coming out of the woodwork. But that’s not what Joanne was talking about. Joanne explained that, in rare moments like these, when we can see the weakness of our institutions, many people slip into irrationality — their own “small-scale delusions.”
She was talking about people like my dad: the hyper-preparers who try to purchase so many garbanzo beans and Purell bottles that the local supermarket implements a one-per-customer rule.
She was talking about people like my brother: the vigilante doctors who stockpile every medication that’s been called a Coronavirus Cure-All by the alt-med press. (My brother, in fact, has acquired 120 doses of hydroxychloroquine, and he’d prefer you didn’t tell his pharmacist that his upcoming six-month trip to malaria-prone Zambia is fake.)
And she was talking about people like me: people who called their ex’s mom, Joanne, under the pretext of writing a story about Framingham, who actually just wanted to incite a late-night reunion. People who only knew enough about Framingham to produce such a convincing pretext because a week earlier they’d spoken to Joanne’s son, their ex, under a similarly compelling, COVID-19-related pretext.
Reaching out to my ex-boyfriend and his mom felt reckless. But something about these troubling times pushed me into nostalgia. And recent headlines like “Coronavirus: Stop texting your ex, it’s not a good idea,” “Why Exes Are Reconnecting in Coronavirus Quarantine” and “Tempted to text your ex during the coronavirus lockdown? You’re not alone” suggest I’m not the only one.
When we look closely at these widespread irrational behaviors, the synchrony of our “small-scale delusions,” we’re transported back to Framingham. Indeed, by pulling back the curtain on our fallible institutions, crises like COVID-19 don’t just unite patients in chronic mental hospitals. They unite us all.
For neurotypical people, trust in institutions is a tool for keeping the outside world out. We’re protected by our self-assurances, by the knowledge that there’s a plan for this.
But when these institutions falter, we are left defenseless, and the stressors of the outside world begin to creep inward. We project our fears onto unwarranted canvases and take disproportionate action in response. Gradually, we begin to generate, rather than merely perceive, the world around us. In other words, COVID-19 has caused us to barrel toward what Joanne’s patients experience every day: delusion.
COVID-19 has the potential to show us something powerful — that delusion doesn’t live on the other side of an immutable medical rift. Rather, the pandemic shows that the stuff of delusionality is inside all of us already.
Yet our culture, not simply our medical institutions, continues to obsess over the question of how they are structurally distinct from us. We’re hungry to know what makes a psycho — and we seek to confirm that, whatever it is, we don’t have it.
Perhaps we do this because we resist seeing sanity as a sliding scale, one on which so-called neurotypicals and so-called delusionals are scattered variously rather than divided starkly. We resist acknowledging that there’s nothing we did to deserve sanity and nothing our parents did to earn it for us. We resist seeing the shame in locking away those whom chance did not favor.
We can see this resistance play out in pop culture — “Mindhunter,” “What Makes a Murderer.” And we can see it at Framingham. The goal of the hospital leadership’s no-masks order, then, wasn’t safety — it put staff and patients at exceptional risk. It was to hide the uncertain realities of COVID-19 from patients — to deceive them. Perhaps the leadership feared that patients would see our crumbling world as evidence supporting their delusions. Or perhaps these leaders knew that, if they allowed patients a peek beyond hospital walls, they’d see a panic on the outside that looks uncannily like the panic they feel on the inside.
*“Joanne” and “Framingham State Hospital” are both pseudonyms. All patient names in this article have been changed to protect privacy. All other details are fully accurate.