When I was a first-year resident in psychiatry at University of Rochester Medical Center, I spent a four-month rotation at the Rochester State Hospital to learn about chronic, severe mental illness. One of my responsibilities was to interview 250 of the long-term patients housed there and write a “six-month progress note” on each of them. (I use the term housed because, although everyone seemed kind and caring, resources were scarce and the patients received little or no definitive treatment.)

One of the patients I interviewed was a regressed, disheveled, schizophrenic man in his late thirties who wore a wild stare and displayed palpable physical tension. I was informed that he had not spoken an intelligible sentence in a very long time. I introduced myself, asked how he