A Memoir Inspired by the University of Chicago Psychiatric Ward

Content Warning: Mentions of suicide and psychiatric conditions

Bette Howland’s memoir W-3 has a unique origin story. It was originally published in 1974, launching a short literary career for Howland. After winning a MacArthur grant in 1983, the author disappeared from publishing for the rest of her life. Years after its initial publication, the editor of the Brooklyn-based magazine, A Public Space, picked up a copy of the memoir off a discount rack at a bookstore and was immediately struck by Howland’s prose as well as her unusual life. A Public Space reissued W-3—whose title refers to the University of Chicago’s psychiatric ward that inspired the memoir—in mid 2021, three and a half years after Howland’s death. 

The memoir begins in the days after Howland attempted suicide by swallowing a bottle of pills in her friend, lover, and lifelong correspondent Saul Bellow’s apartment. The attempt occurred while Howland, a single mother, was working as an editor and librarian and struggling to financially support her two children while continuing to write, and it led to an extended period in the University of Chicago Medicine psychiatric ward. 

Howland’s story, filled with inherent curiosities, is backed up by a complex and masterful literary voice. Throughout W-3, Howland renders the intense realities of the psychiatric ward in precise and guarded prose that reveals her to be, above everything else, an observer. In the moments that she does reveal her interiority, Howland proves herself to be unafraid of the brutality of her own observations no matter where her gaze is directed.  

W-3 opens in the intensive care unit where Howland woke up from a coma after her suicide attempt, with no voice and “no ‘mood,’ that is to say, no surplus,” Howland writes. Howland describes her convalescence as continuing this way; cleaved from all self-governance and passive. But under the surface her sharp powers of judgment simmer, a fact that becomes extremely clear when she moves to W-3 and begins to describe the people that she meets in the ward. 

Howland structures the book in tight self-contained episodes that highlight various characters that live on the ward. The names of her peers are so numerous that it is easy to get confused, but the behaviors that Howland describes are hard to forget. Trudy lifts up her skirts to reveal a backside pocked with penicillin injections for gonorrhea. Basil speaks with such sincere emotion that he moves the listener—until his inability to stop talking becomes disturbing. Fran arrives at the ward unresponsive and unwashed and is brought back to vibrancy when she is assigned a secretary role for patient meetings. 

Howland does not coddle the reader, nor does she spare the dignity of her fellow patients by softening her portraits. She describes meal time at the ward as “disgusting,” a battered woman’s bruises as “freakish,” and another patient on the ward as looking like “a fat baby.” 

In one memorable scene, Howland expresses disbelief at another patient’s outburst: “‘I’ve had intercourse with forty-three men…But I only had orgasms a few times…Just a few times! Almost never!’ And here the throat bulged, the big painted mouth crumpled bitterly; she lowered her face and hung her head…I was stunned. This was a textbook. Can it be that she only read it somewhere?” 

The behaviors of patients going through major mental health crises strike Howland as so obvious that they are occasionally unbearable to her. Yet even as she watches, Howland understands that she belongs at W-3 as much as any other patient. She is not “acting out” in the same way that she describes her peers as doing, and as a highly educated woman, she acknowledges her socioeconomic privilege within the ward, but even so Howland is not disunited from her peers: “Every time I observed some outburst, some dissident behavior on the ward,” Howland says, “I would feel the same urge, the same strong temptation…the same thought would pop into my head, with the force of novelty – the way ideas occur to a child’s mind: Hmm. Maybe I should try that too?” 

Howland acknowledges the dual reality of her perspective. She identifies with her peers, and yet she sees the ward from a vantage point that divests the behaviors of their disturbing reality. Howland’s descriptions are cool, almost to the point of being cold—but the revulsion, humor, and absurdity that she brings to her analysis of the ward itself are where she reveals her tough mind. Of W-3, she writes, “the patients existed for the sake of the hospital, not the other way around…Once you understood this, it was simple, everything fell into place. Only it was the last thing that would ever occur to you.” 

In many ways, W-3 feels like a time capsule delivered with contemporary lucidity. In fact, it often feels strangely up-to-date with the lexicon and language norms of today, which have changed considerably since the time that W-3 was published. When Howland describes the specter of the “divorcée,” the identity in which she now lives, stalking her worth in society, it recalls Italian novelist Elena Ferrante’s embodied symbols that haunt women in patriarchal structures. Only Howland is not superimposing any new lens onto the past—she is narrativizing her present.

Also fascinating is Howland’s unadorned description of hair maintenance for Black women on the ward: “Hair was always a problem, but for black women it was a scourge.” Howland goes on to describe her Black peers desperately ironing their hair with the tools they could find on the ward: “By night the kitchen reeked of strong burning hair.” By paying attention, Howland is describing the racial hair politics of the time that still have relevance today. 

Howland’s purposely positioned gaze as an observer creates a sort of distance that contrasts with the physical and emotional closeness that she has with her peers on the ward, a racially diverse group that reflects the city of Chicago. For a white woman in the 1960s, it might have been an anomaly to feel that camaraderie with people of different backgrounds, but Howland was a Jewish woman living in Uptown, a much more diverse neighborhood than it is today. Most likely, this impression of distance was just as much a writing device as a lived experience. 

When the realities of the 60’s hit, however, they are deeply unnerving. Howland describes multiple instances of medical abuse that are devastating, as is the revelation that Howland was remanded to W-3 to avoid jail time for the crime of “attempted suicide.” 

For a book that so often looks outward, W-3 has moments of introspection that are as critical as the rest. It is, therefore, more surprising when Howland is tender with herself and with others. When staff release Howland from the ward, she leaves behind Gerda, a suicidal woman who Howland describes as having “a sort of force field…that both pulled and repelled me.” Howland identifies with Gerda, which is why she rejects her. Gerda will not stop attempting suicide. Howland realizes what Gerda seems to already know: suicide is not what it promises to be. “There is nothing sacrosanct about suicide,” Howland writes. 

After her release, Howland returns once to the ward, and realizes that she has been transformed into a visitor. She’s no longer of W-3, even as she searches for Gerda and finds her recovering from yet another suicide attempt. “And I had thought that things had changed!” Howland exclaims. “Now I saw my error: the place was immutable. Things were always changing, things were always the same.” 

It feels strange to pick up a book by a nearly forgotten writer because of their association to one of the American greats and discover what almost disappeared. Saul Bellow, a suicide attempt, the genius grant, an abandoned career—Howland’s writing offers even more than the captivating story behind it. In W-3, Howland’s unforgiving descriptions disallow the reader from moving unfeelingly through the psychiatric ward where she witnessed so much. 

In that hardness there is recognition, and in that recognition, compassion. Howland’s writing demands the same recognition, even if, like her, it had to be lost before it could be found.

Correction, April 12, 2022: A previous version of this story incorrectly stated Howland’s release date from W-3. We apologize for the innacuracy.

Sage Behr is an actor, writer, and barista originally from Iowa City. She previously interviewed Evan Moore, the co-author of Game Misconduct.